一法。冬时有非节之暖。未至而至。即为不正之气。独冬不藏精之人。肾气外泄。腠
理不固。温气袭人。感之为病。此为冬温。脉必寸洪尺数。或实大。心烦呕逆。身热
不恶寒。或头疼身重。面肿咳嗽。咽痛下利。与温无异。而时令不同也。宜阳旦汤。加桔梗、茯苓。
一法。若有寒食停滞。加浓朴温药一味。以温散其中。黄芩凉解其外。即仲景阴旦汤之意也。
一法。若先感温气。即被严寒遏抑。则发热而微畏寒。汗不出而烦扰。阳旦加麻黄、石膏发之。
一法。医视冬温。每有误认伤寒。辛热发汗。致令发斑成毒者。当以升麻葛根汤。加
犀角、黑参。或犀角黑参汤。
一法。更有辛热发汗。徒耗津液。里热益甚。胸腹满闷。因误用下药。反发热无休止。
脉来涩。此阴血受伤也。急宜葶苈苦酒汤探之。以收阴气。泄邪热。若服后热势
转剧。神气昏愦。谵语错乱者。必不救也。冬温为病。亦自不一。当各随见证治之。
凡冬温之毒。大便泄而谵语。脉虚小。手足冷者。皆不治也。
一法。春时温病未愈。适复感寒。忽作寒热者。温疟也。阴阳例云。脉阴阳俱盛。重感
于寒。变为温疟。其证寒热交作。胸胁满。烦渴而呕。微恶寒者。小柴胡去参、半。加栝蒌根、石膏。
一法。无寒但热。其脉平。骨节烦疼。时呕者。黄芩加生姜汤。至如内经所言。先热后
寒之温疟。乃得之冬中于风。寒气藏骨髓之内。至春阳气大发之时。邪气不能
自出。因遇大暑。脑髓烁。肌肉消。腠理发泄。或有劳力。邪气与汗共并而出。此病
藏于肾。自内达外者也。如是则阴气虚而阳邪盛。故为热。热盛则必衰。衰则气
反而复入。入则阳虚。阳虚则又寒矣。故先热后寒。名曰温疟。治宜人参白虎汤。
周禹载曰。或有客邪。则必先微恶寒。继大热。热而后大寒者也。本汤中略用桂
枝。此伏邪自发之温疟。与温病复感外邪之温疟。自是两种。
One method. In winter, there may be unseasonal warmth. The cold qi has not yet arrived, but the warm qi arrives prematurely; this is referred to as "abnormal qi" (bu zheng zhi qi). Only individuals who failed to conserve their essence during winter will have their Kidney Qi leaking outward and their interstices (cou li) insecure. When warm pathogens invade the person, contracting the disease results in Winter-Warmth (Dong Wen). The pulse must be surging at the Cun position and rapid at the Chi position, or solid and large, accompanied by mental restlessness, vomiting, and rebellious qi. The body is hot without aversion to cold, or there may be headache and heaviness of the body, facial swelling, cough, sore throat, and diarrhea. These symptoms are no different from Warmth diseases, except for the timing of the season. It is appropriate to use Yang Dan Decoction (Yang Dan Tang), adding Platycodon Root (Jiegeng) and Poria (Fuling).
Another method. If there is stagnation of cold food, add one dose of a warming herb such as Magnolia Bark (Noupu) to warm and disperse the interior accumulation. Use Scutellaria Root (Huangqin) to cool and resolve the exterior heat. This aligns with the intent of Zhang Zhongjing's Yin Dan Decoction (Yin Dan Tang).
Another method. If one first contracts warm pathogens and is then suppressed by severe cold, fever occurs with slight aversion to cold, absence of sweating, and mental agitation. One should use Yang Dan Decoction (Yang Dan Tang) added with Ephedra Herb (Mahuang) and Gypsum (Shigao) to induce sweating and release the pathogen.
Another method. Physicians treating Winter-Warmth often mistakenly diagnose it as Cold Damage (Shang Han) and use acrid-warming herbs to induce sweating, leading to the manifestation of macules and toxin formation. In such cases, one should use Bupleurum and Rehmannia Decoction (Shengma Ge Gen Tang), added with Rhinoceros Horn (Xijiao) [note: substitute with alternative legally available material] and Black參 (Heishen, i.e., Scrophularia Root/Xuanshen), or use Rhinoceros Horn and Black參 Decoction (Xijiao Heishen Tang).
Another method. Furthermore, if acrid-warming sweating methods were used improperly, merely depleting body fluids, the interior heat becomes even more severe, causing fullness and oppression in the chest and abdomen. Due to the mistaken use of purgative drugs, fever persists without cessation. The pulse comes in a choppy manner, indicating injury to Yin blood. One urgently needs to probe treatment with Tingli Kujiu Tang (Descurainia Seed and Vinegar Decoction) to gather Yin Qi and drain evil heat. If after taking the medicine the fever intensifies, consciousness becomes confused, and delirious speech occurs with confusion, recovery is impossible. Winter-Warmth presents in various ways; treatment must follow the specific manifestations. For any Winter-Warmth toxicity where there is diarrhea with delirium, a deficient and small pulse, and cold hands and feet, these are all untreatable conditions.
Another method. When a Spring Warmth disease is not yet cured, and one happens to contract cold again, suddenly presenting with alternating chills and fever, this is called Warm Malaria (Wen Nue). The *Yin Yang Li* states: when pulses at all three positions (Cun, Guan, Chi) are vigorous, and one contracts cold again, it transforms into Warm Malaria. Its symptoms include alternating chills and fever, fullness in the chest and hypochondrium, mental irritability, thirst, vomiting, and slight aversion to cold. Treat with Xiao Chai Hu Decoction (Minor Bupleurum Decoction), removing Ginseng and Pinellia Tuber, adding Trichosanthes Root (Gualougen) and Gypsum (Shigao).
Another method. If there is no aversion to cold but only fever, with a normal pulse, vexing pain in the bone joints, and occasional vomiting, use Huangqin Jia Shengjiang Tang (Scutellaria Decoction with Added Ginger). As stated in the *Neijing*, the Warm Malaria characterized by fever preceding chills arises from contracting wind in winter, where cold qi hides within the bone marrow. When spring arrives and Yang Qi expands vigorously, the pathogenic qi cannot exit on its own. If encountering intense summer heat, which scorches the brain marrow and consumes muscle tissue, causing the interstices to open and sweat, or due to physical exertion, the pathogenic qi exits together with the sweat. This disease resides in the Kidney, moving from the interior to the exterior. In such cases, Yin Qi is deficient while Yang pathogenic factors are excessive, thus manifesting as heat. When heat is extreme, it must decline; upon declining, the Qi reverses and re-enters. Upon entering, Yang becomes deficient; when Yang is deficient, cold manifests again. Hence, fever precedes chills, named Warm Malaria. Treatment should utilize Renshen Baihu Tang (Ginseng White Tiger Decoction). Zhou Yuzai said: If there is an exogenous pathogen, there must first be slight aversion to cold, followed by high fever, and after the fever, severe chills. The slight use of Cinnamon Twig (Guizhi) in this decoction addresses Warm Malaria arising from latent pathogens spontaneously activating, which is distinct from Warm Malaria resulting from a recurrence of Warmth disease compounded by external pathogen contraction.