《伤寒论》曰∶发热而渴,不恶寒者为温病,后人省“ ”加“ ”为瘟,即温也。
如
病证之“证”,后人省文作“证”,嗣后省“言”加“ ”为症。又如滞下,古人为下利脓血,盖以
泻为下利,后人加“ ”为“痢”。要之,古无瘟、痢、症三字,皆后人之自为变易耳,不可因
易其文,以温瘟为两病,各指受病之原,乃指冬之伏寒,至春至夏发为温热,又以非节之暖
为
温疫,果尔,又当异证异脉,不然临治之际,何以知受病之原不同也。设使脉病不同,病原各
异
,又当另立方论治法,然则脉证治法,又何立哉?所谓枝节愈繁,而意愈乱,学人未免有多岐
之
惑矣。夫温者热之始,热者温之终,温热首尾一体,故又为热病即温病也。又名疫者,以其延
门阖户,如徭役之役,众人均等之谓也。今省文作“ ”加“ ”为疫。又为时疫时气者
,因其感时行戾气所发也,因其恶厉,又为之疫疠,终有得汗而解,故燕冀名为汗病。此外
,又有风温、湿温,即温病挟外感之兼证,名各不同,究其病则一。然近世称疫者众,书以
温疫者,弗遗其言也。后以伤寒例及诸家所议,凡有关于温疫,其中多有误者,恐致惑于
来学,悉采以正焉。
《阴阳大论》云∶春气温和,夏气暑热,秋气清凉,冬气冷冽,此则四时正气之
序
也。冬时严寒,万类深藏,君子固密,则不伤于寒。触冒之者,乃名伤寒耳。其伤于四时之
气,皆能为病,以伤寒为毒者,以其最成杀厉之气也。中而即病者,名曰伤寒,不即病者,
寒毒藏于肌肤,至春变为温病,至夏变为暑病,暑病者,热极重于温也。
成注《内经》曰∶先夏至为温病,后夏至为暑病,温暑之病,本于伤寒而得之。
正误∶按∶十二经络,与夫奇经八脉,无非营卫气血,周布一身而营养百骸。是以天真元气,无往
不
在,不在则麻木不仁。造化之机,无刻不运,不运则颠倒仆绝。然风寒暑湿之邪,与吾身
之
营卫,势不两立,一有所干,疾苦作矣,苟或不除,不危即毙。上文所言冬时严寒所伤,中
而即
病者为伤寒,不即病者,至春变为温病,至夏变为暑病。然风寒所伤,轻则感冒,重则伤寒
,即感冒一证,风寒所伤之最轻者,尚尔头疼身痛、四肢拘急、鼻塞声重、痰嗽喘急、恶寒
发热,当即为病,不能容隐,今冬时严寒所伤,非细事也,反能藏伏过时而发耶?更问何等
中而即病?何等中而不即病?何等中而即病者头痛如破,身痛如杖,恶寒项强,发热如炙,或
喘或呕,甚则发痉,六脉疾数,烦躁不宁,至后传变,不可胜言,仓卒失治,乃致伤生;何
等中而不即病者,感则一毫不觉,既而延至春夏,当其已中之后,未发之前,饮食起居如常
,神色声气,纤毫不异,其已发之证,势不减于伤寒。况风寒所伤,未有不由肌表而入,所
伤皆营卫,所感均系风寒,一者何其 懵,中而不觉藏而
不知;一者何其灵异,感而即发。发而根属同源而异
流,天壤之隔,岂无说耶?既无其说,则知温热之原,非风寒所中矣。且言寒毒藏于肌肤之
间
,肌为肌表,肤为皮之浅者,其间一毫一窍,无非营卫经行所摄之地,即感冒些小风寒,尚
不能稽留,当即为病,何况受严寒杀厉之气,且感于皮肤最浅之处,反能容隐者耶?以此
推之,必无是事矣。凡治客邪大法,要在表里分明,所谓未入于腑者,邪在经也,可汗而已
;既入于腑者,邪在里也,可下而已。果系寒毒藏于肌肤,虽过时而发,邪气犹然在表,治
法不无发散,邪从汗解。后世治温热病者,若执肌肤在表之邪,一投发散,是非徒无益,而
又害之矣!
凡病先有病因,方有病证,因证相参,然后始有病名,稽之以脉,而后可以言治。假令伤寒
中暑,各以病邪而立名,今热病以病证而立名,上文所言暑病,反不若言热病者,尚可模糊,
若以暑病为名,暑为病邪,非感盛夏之暑,不可以言暑病,若言暑病,乃是香薷饮之证,彼此岂
可相混?凡客病感邪之重,则病甚,其热亦甚;感邪之轻,则病轻,其热亦微,热之微
甚,存乎感邪之轻重也。二、三月及八、九月,其时亦有病重,大热不止,失治而死者。
五、六月
亦有病轻热微不药而愈者。凡温病四时皆有,但仲夏感者多,春秋次之,冬时又次之,但可
以时令分病之多寡,不可以时令分热之轻重也。
是以辛苦之人,春夏多温热病者,皆由冬时触寒所致,非时行之气也。凡时行者,春应
暖而反大寒,夏应大热而反大凉,秋时应凉而反大热,冬时应寒而反大温,此非其时有其气
,是以一岁之中,长幼之病多相似者,此则时行之气也。
然气候亦有应至而不至,或有至而太过者,或未应至而至者,此成病气也。
正误∶春温、夏热、秋凉、冬寒乃四时之常,因风雨阴晴稍为损益。假令春应暖而反多寒,其时必
多雨;秋应凉而热不去者,此际必多晴;夫阴晴旱潦之不测,寒暑损益安可以为拘?此天地
四时之常事,未必为疫。夫疫者,感天地之戾气也。戾气者,非寒、非暑、非暖、非凉,亦
非四时交错之气,乃天地别有一种戾气,多见于兵荒之岁,间岁亦有之,但不甚耳。上文所
言,长幼之病多相似者,此则为时行之气,虽不言疫,疫之意寓是矣。盖缘不知戾气为交错之气而为疫,
殊不知四时之气,虽
损益于其间,及其所感之病,终不离其本源。假令正、二月应暖,偶因风雨交集,天气不
温暖,而多春寒。所感之病,轻则为感冒,重则为伤寒,原从感冒伤寒法治之,但春寒之气,
终不若冬时严寒杀厉之气为重,投剂不无有轻重之分,此即应至而不至,至而不去二事也。
又如八九月,适多风雨,偶有暴寒之气先至,所感之病,大约与春寒仿佛,深秋之寒,终不
若冬时杀厉之气为重,此即未应至而至。即冬时严寒倍常,是为至而太过,所感亦不过即病
之伤寒耳。假令夏时多风雨,炎威少息,为至而不及。时多亢旱,烁石流金,为至而太过。
太过则病甚,不及则病微,至于伤暑一也,其病与四时正气之序何异耶?治法无出于香薷饮
而已。
其冬时有非节之暖,名曰冬温。
正误∶此即未应至而至也。按∶冬伤于寒,至春变为温病,今又以冬时非节之暖为冬温。一感于冬
寒
,一感于冬温,一病两名,寒温悬绝,然则脉证治法又何似耶?夫四气乃二气之离合也,二
气即一气之升降也,升极则降,降极则升;升降之极,为阴阳离,离则亢,亢气致病。
亢
气者冬之大寒,夏之大暑也。将升不升,将降不降,为阴阳合,合则气和,气和则不致病。
和
气者即春之温暖,秋之清凉也。是以阴极而阳气来和,为温暖;阳极而阴气来和,为清凉,
斯有既济之道焉。《易》曰∶一阴一阳为之道。偏阴偏阳为之疾。得其道,未有反致其疾者。若夫春寒
秋热,为冬夏之偏气,倘有触冒之者,固可以为疾;亦无出于感寒伤暑,未可以言疫。若夏凉冬暖,
转得春秋之和气,岂有因其和而反致疾者?所以但见伤寒中暑,未尝见伤温和而中清凉也。
温暖清凉,未必为病,又乌可以言疫?
从春分以后至秋分节,天有暴寒者,此皆时行寒疫也。三月四月,或有暴寒,其时阳气尚
弱,为寒所折,病热犹轻。五、六月,阳气已盛,为寒所折,病热为重。七、八月,阳气已
衰,为寒所折,病热亦微,其病与温暑相似,但有殊耳。
正误∶按∶四时皆有暴寒,但冬时感严寒杀厉之气,名伤寒,为病最重,其余三时寒微,为病亦微
。又
以三时较之,盛夏偶有些小风寒,所感之病更微矣。此则以感寒之重,病亦重而热亦重;感
寒之轻,病亦轻而热亦轻。是重于冬而略于三时,至夏而又略之,此必然之理也。上文所言
,
三四月,阳气尚弱,为寒所折,病热犹轻;五六月,以其时阳气已盛,为寒所折,病热为
重
;七八月其时阳气已衰,为寒所折,病热亦微。由是言之,在冬时阳气潜藏,为寒所折,病
热更微,此则反见夏时感寒为重,冬时感寒为轻,前后矛盾,于理大违。交春夏秋三时,偶
有暴寒所着,与冬时感冒相同,治法无二,但可名感冒,不当另立寒疫之名。若又以疫为名
,殊类画蛇添足。
The *Shanghan Lun* (Treatise on Cold Damage) states: "Fever accompanied by thirst and aversion to cold absent is termed Wenbing (Warm Disease). Later generations abbreviated the character 'Zheng' (Syndrome/Pattern) and added the grass radical to write 'Wen' (Plague), which means the same as Wen." Just as the 'Zheng' in Bingzheng (Disease Syndrome) was simplified to 'Zheng', later the speech radical was omitted and the disease radical added to write 'Zheng' (Symptom). Similarly, 'Zhi Xia' (Stagnant Downward Flow), used by ancients to refer to dysentery with pus and blood in stool, likely because diarrhea was called 'Xia Li' (Downward Flowing Diarrhea), later had the disease radical added to become 'Li' (Dysentery). In summary, the characters for 'Wen' (Plague), 'Li' (Dysentery), and 'Zheng' (Symptom) did not exist in ancient times; they were alterations made by later generations. One should not, due to these textual changes, treat Warm Disease (Wenbing) and Plague (Wen) as two different diseases with distinct etiologies. If it were claimed that winter latent cold transforms into warm-heat conditions in spring or summer, and non-seasonal warmth is termed Warm Epidemic (Wenyi), then if this were true, the syndromes and pulses should differ. Otherwise, during treatment, how would one know the etiological origins are different? If pulses and syndromes differ and etiologies vary, new formulas, theories, and treatments should be established. In that case, what purpose do existing pulse-syndrome-treatment methods serve? The more branches one adds, the more confused the intent becomes, causing learners to suffer from confusion over multiple paths. 'Wen' (Warmth) is the beginning of heat; 'Re' (Heat) is the end of warmth. Warmth and heat form a single continuum from start to finish; thus, Rebing (Heat Disease) is synonymous with Wenbing (Warm Disease). It is also called 'Yi' (Epidemic) because it spreads door-to-door like corvée labor, affecting everyone equally. Now, the character is written as 'Yi' by adding the disease radical. It is also called Shiyi (Seasonal Epidemic) or Shiqi (Seasonal Qi) because it arises from contracting the pathogenic qi of the season. Due to its malicious nature, it is also called Yili (Epidemic Miasma). Ultimately, resolution occurs through sweating, hence in the Yan-Ji region, it is called Hanbing (Sweat Disease). Additionally, there are Fengwen (Wind-Warmth) and Shiwen (Damp-Warmth), which are concurrent syndromes of Warm Disease complicated by external contractions. Though named differently, their underlying pathology is identical. However, in recent times, many call conditions 'Yi', and writings on Wenyi omit none of these statements. Subsequently, regarding the *Shanghan Li* (Example of Cold Damage) and various scholarly discussions concerning Wenyi, much contains errors that may confuse future students. Therefore, I have collected them all to correct them.
The *Yinyang Dalun* (Great Treatise on Yin and Yang) states: "Spring qi is mild and warm, summer qi is hot and sultry, autumn qi is cool and clear, winter qi is cold and piercing. This is the order of the upright qi of the four seasons. In winter, severe cold causes all things to hide deeply. The gentleman maintains his integrity and secrecy, thus avoiding injury by cold. Those who violate this are named as having Shanghan (Cold Damage). Injury by the qi of the four seasons can all cause disease. Cold damage is considered the most toxic because it forms the most killing and malignant qi. If illness occurs immediately upon injury, it is named Shanghan. If it does not occur immediately, the cold toxin hides in the skin and muscles. By spring, it transforms into Wenbing (Warm Disease); by summer, it transforms into Shubing (Summer Heat Disease). Shubing involves extreme heat, heavier than Wenbing."
Cheng Wuji's commentary on the *Neijing* states: "Illness occurring before the Summer Solstice is Wenbing; after the Summer Solstice is Shubing. Both Wenbing and Shubing originate from Shanghan."
[Correction]: According to my analysis: The twelve meridians and the eight extraordinary vessels are nothing but Ying and Wei (Nutritive and Defensive) Qi and Blood, distributed throughout the body to nourish the hundred bones. Thus, Tianzhen Yuanqi (Innate Primal Qi) exists everywhere; where it is absent, there is numbness and insensitivity. The mechanism of creation operates without pause; if it stops, collapse and death ensue. However, pathogens such as Wind, Cold, Summer Heat, and Dampness stand in opposition to the body's Ying and Wei. Once disturbed, illness and suffering arise. If not eliminated, danger or death follows. The text above mentions that injury by winter severe cold leads to immediate illness named Shanghan, while delayed illness transforms into Wenbing in spring and Shubing in summer. Yet, injury by Wind and Cold results in mild cases of Ganmao (Common Cold) and severe cases of Shanghan. Even Ganmao, the mildest form of Wind-Cold injury, presents with headache, body pain, limb stiffness, nasal congestion, heavy voice, phlegm-cough, asthma, aversion to cold, and fever. It manifests immediately and cannot be hidden. Winter severe cold is no trivial matter; how could it lie dormant and manifest only after a season has passed? Furthermore, which cases manifest immediately? Which do not? Which immediate cases present with splitting headaches, body pain like being beaten, aversion to cold, stiff neck, burning fever, asthma, vomiting, convulsions, rapid and numerous pulses, and restlessness? Such cases, if mistreated hastily, lead to death. Which delayed cases show no sensation upon contraction, remain asymptomatic until spring or summer, with normal diet, sleep, expression, voice, and breath prior to onset, yet once manifested, the severity rivals Shanghan? Moreover, Wind-Cold always enters via the exterior, injuring Ying and Wei. Why is one so oblivious—feeling nothing and hiding unknowingly—while the other is so spiritual—manifesting immediately? Though originating from the same source, they diverge completely, separated by heaven and earth. Is there no explanation? Since there is none, we know the origin of Warm-Heat is not caused by Wind-Cold invasion. Also, claiming cold toxin hides in the skin and muscles is flawed. 'Ji' refers to muscle surface, 'Fu' to superficial skin. Every pore and hair follicle is traversed by Ying and Wei meridians. Even slight Wind-Cold cannot linger; it causes immediate illness. How much less could severe, killing cold qi, entering at the shallowest skin level, remain concealed? By this reasoning, such a scenario is impossible. The general principle for treating exogenous pathogens requires distinguishing interior and exterior clearly. If the pathogen has not entered the Fu organs, it remains in the Jing meridians and can be resolved by sweating. If it has entered the Fu organs, it is in the interior and can be resolved by purging. If cold toxin truly hid in the skin and muscles, even if delayed, the pathogen remains in the exterior, requiring dispersing methods to resolve via sweat. Later generations treating Warm-Heat diseases, if they cling to the notion of exterior pathogens in the skin and muscles and use dispersing methods, will achieve neither benefit nor harm!
Every disease has an etiology before presenting with symptoms. Correlating etiology and symptoms establishes the disease name, verified by pulse diagnosis, before treatment can be discussed. For instance, Shanghan and Zhongshu (Summer Heat Strike) are named after their pathogenic factors. Currently, Rebing (Heat Disease) is named after its syndrome. Regarding the Shubing mentioned above, calling it Rebing allows for ambiguity. If named Shubing, 'Shu' is the pathogen; unless one contracts summer heat in midsummer, it cannot be called Shubing. Referring to Shubing implies the syndrome of Xiangru Yin (Mosla Decoction). How can these be confused? Generally, heavy pathogenic contraction leads to severe illness and high fever; light contraction leads to mild illness and low-grade fever. The degree of heat depends on the severity of the pathogen. In February-March and August-September, severe cases with unceasing high fever leading to death from mistreatment do occur. In May-June, mild cases with low-grade fever often heal spontaneously. Wenbing occurs in all seasons, but is most common in midsummer, followed by spring and autumn, and least in winter. Seasonality determines the frequency of disease, not the severity of heat.
Therefore, hardworking people often suffer Warm-Heat diseases in spring and summer, caused by winter cold exposure, not by seasonal epidemic qi. Seasonal epidemic qi occurs when spring should be warm but is severely cold, summer should be hot but is cool, autumn should be cool but is hot, and winter should be cold but is warm. This is "having the qi out of season," causing similar illnesses among young and old throughout the year. This is seasonal epidemic qi.
However, climate may fail to arrive when expected, arrive excessively, or arrive prematurely. These create pathogenic qi.
[Correction]: Spring warmth, summer heat, autumn coolness, and winter cold are the norms of the four seasons, varying slightly with wind, rain, clouds, and sun. If spring should be warm but is cold, it must be rainy. If autumn should be cool but remains hot, it must be sunny. The unpredictability of weather and the variation of cold and heat are natural phenomena of heaven and earth, not necessarily epidemics. An epidemic is caused by Tianli Zhi Liqi (Malignant Qi of Heaven and Earth). Liqi is neither cold, nor heat, nor warmth, nor coolness, nor a mix of seasonal qi. It is a unique type of malignant qi found mostly in years of war and famine, occasionally in other years, though less severe. The aforementioned similarity of illnesses among young and old refers to seasonal epidemic qi. Though not explicitly called an epidemic, the concept is implied. People mistakenly believe that mixed seasonal qi causes epidemics, failing to realize that despite variations in seasonal qi, the resulting diseases remain rooted in their original sources. For example, in January and February, weather should be warm, but due to wind and rain, it remains cold. Diseases contracted range from mild Ganmao to severe Shanghan, treated accordingly. Spring cold is never as severe as winter killing cold, so medication dosage varies. This corresponds to "arriving late" and "lingering too long." Similarly, in August and September, sudden cold arrives early. Diseases resemble those of spring cold. Late autumn cold is still less severe than winter killing cold. This is "arriving early." Extreme winter cold is "excessive arrival," causing immediate Shanghan. Excessive summer rain cooling the heat is "insufficient arrival." Severe drought is "excessive arrival." Excess causes severe illness; insufficiency causes mild illness. Regarding Summer Heat injury, the pathology is the same regardless. What difference does this make from the order of upright seasonal qi? Treatment relies solely on Xiangru Yin.
Non-seasonal warmth in winter is called Dongwen (Winter Warmth).
[Correction]: This is "arriving early." Note: Winter cold injury transforming into Warm Disease in spring differs from Winter Warmth caused by non-seasonal warmth in winter. One contracts winter cold, the other winter warmth. One disease, two names, with opposite natures (cold vs. warm). How could their pulses, syndromes, and treatments be similar? The Four Qi are the separation and union of Yin and Yang. Yin and Yang are the ascending and descending of one Qi. Ascending reaches its peak and descends; descending reaches its peak and ascends. At the extremes of ascent and descent, Yin and Yang separate. Separation leads to hyperactivity (Kang), and hyperactive qi causes disease. Hyperactive qi is the severe cold of winter and severe heat of summer. When ascent fails and descent fails, Yin and Yang unite. Union brings harmony (He). Harmonious qi does not cause disease. Harmonious qi is the warmth of spring and coolness of autumn. Thus, when Yin reaches its extreme, Yang comes to harmonize, creating warmth. When Yang reaches its extreme, Yin comes to harmonize, creating coolness. This is the way of Ji Ji (Completion/Intersection). The *I Ching* says: "One Yin and one Yang constitutes the Dao." Deviation into Yin or Yang constitutes disease. Following the Dao prevents disease. Spring cold and autumn heat are biased qi of winter and summer. If contracted, they certainly cause illness, but this is merely cold injury or summer heat strike, not an epidemic. If summer is cool and winter is warm, one obtains the harmonious qi of spring and autumn. Could harmony cause disease? We see Shanghan and Zhongshu, but never injury by warmth or coolness. Warmth and coolness do not necessarily cause disease; how can they be called epidemics?
From the Spring Equinox to the Autumn Equinox, sudden cold spells constitute Seasonal Cold Epidemic (Shixing Hanyi). In March and April, sudden cold occurs when Yang Qi is still weak; suppressed by cold, the feverish aspect is mild. In May and June, Yang Qi is strong; suppressed by cold, the feverish aspect is severe. In July and August, Yang Qi is declining; suppressed by cold, the feverish aspect is mild. The illness resembles Warmth and Summer Heat but differs slightly.
[Correction]: Sudden cold occurs in all seasons. Winter injury by severe killing cold is named Shanghan and is the most severe. Cold in other seasons is mild, causing mild illness. Comparing the three non-winter seasons, slight Wind-Cold in midsummer causes even milder illness. Severity of cold correlates with severity of illness and heat. Winter is heaviest, followed by decreasing severity in other seasons, reaching minimum in summer. This is logical. The text claims Yang Qi is weak in March-April (mild fever), strong in May-June (severe fever), and declining in July-August (mild fever). Conversely, in winter, Yang Qi is hidden; suppression by cold should result in even milder fever. This contradicts the claim that summer cold injury is severe and winter cold injury is mild. It is logically inconsistent. Sudden cold in spring, summer, and autumn is identical to winter Ganmao. Treatment is the same. It should only be called Ganmao, not separately named Cold Epidemic. Adding "Epidemic" to this name is superfluous.