此一卷论伤寒、伤风、热病、中暑、温病、温疟、风温、温疫、中湿、湿温、 病、温毒之名。
天下之事。名定而实辨。言顺则事成。又况伤寒之名。种种不同。若识其名。纵有差失。功有浅深。
效有迟速耳。不得其名。妄加治疗。往往中暑乃作热病治之。反用温药。湿温乃作风温治之。复加
发汗。名实混淆。是非纷乱。性命之寄。危于风烛。今于逐问下详载疾状而名之曰某病。庶几因名
识病。因病识证。如暗得明。胸中晓然。而处病不瘥矣。
（三十八）问脉浮而紧涩。头疼身体拘急。恶寒无汗。寒多热少。面色惨而不舒。腰脊疼痛。手
足指末微厥。不烦躁。
此名伤寒也。伤寒之候。发热恶寒。头疼腰脊痛。脉紧无汗。宜发汗而解。麻黄汤主之。（正二十）轻者
只与桂枝麻黄各半汤（正二）。又人参顺气散（杂三十）。葱豉汤。（杂七四）苍术散。（杂三一）麻黄葛根汤（杂三十二）
可选而用之。○然太阳病
亦有热多寒少者。须仔细看脉与证也。热多寒少不呕清便自可。宜桂枝麻黄各半汤。若脉浮者。虽
热多寒少。自可发汗。若脉弱者无阳也。桂枝二越婢一汤主之（正四）。热多寒少而尺脉迟者。营气不足血
少故也。先以小建中汤（正三十七）加黄 最良。尺脉尚迟。再作一剂。○或太阳证宜汗而其人适失血及下利。
则频频与少桂枝汤（正乙）。使体润。 连日。当自解。○假如淋家衄血家法不可汗。亦可用小柴胡（正二十九）之类
和解之。
（三十九）问脉浮而缓。寸大而尺弱。自汗体热。头疼恶风。热多寒少。其面光而不惨。烦躁。
手足不冷。
此名伤风也。伤风之候。头疼发热。脉缓。汗出恶风。当须解肌。宜桂枝汤主之（正一）。轻者只与柴
胡桂枝汤（正三十一）。败毒散（杂三十三）。独活散（杂三十四）。可选用之。治太阳中风。有汗用桂枝汤。凡脉紧必
无汗。唯濡而
紧。却自汗。勿误用小建中汤也。（正三十七）须是脉浮而缓者。方可用桂枝也。项背强者。桂枝汤加葛根也（正十八）。
（本草葛根主伤风有湿。开窍解肌。盖桂枝加葛根者。谓中风有湿。当加之去其风湿。取微汗者。
风湿去也）里寒者。桂枝去芍药加附子汤也。（正八）（不饮水者是也）凡发汗后。汗不止为漏风。桂
枝加附子汤主之。（正六）腹满者。太阴证。脉浮者。可服桂枝汤微发汗。腹痛者。桂枝加芍药汤。（正十二）痛甚者。
桂枝加大黄汤也。（正十三）○虽然。桂枝汤。自西北二方居人。四时行之。无不应验。自江淮间。唯冬及春
初可行。自春末及夏至以前。桂枝证可加黄芩半两。阳旦汤是也（杂百十六）。夏至后有桂枝证。可加知母
一两。石膏二两。或加升麻半两。若病患素虚寒者。正用古方。不在加减也。（岐伯所谓同病异治
者此也。大抵用温药当避春。用热药当避夏。素问所谓用温远温。用热远热者也）○又问伤寒与
伤风何以别之。伤寒者。脉紧而涩。伤风者。脉浮而缓。伤寒者无汗。（脉涩故也）伤风者有汗。
伤寒者畏寒不畏风。伤风者畏风不畏寒。大抵太阳病者。必脉浮发热恶风恶寒也。恶寒者不当风而
自增寒。恶风者当风而增寒也。六经皆有伤寒伤风。其证各异。太阳脉浮有汗为中风。脉紧无汗。
为伤寒。阳明善饥为中风。不食为伤寒。少阳两耳聋目赤胸满而烦为中风。口苦咽干目眩为伤寒。
若三阴伤风无变异形证。但四肢烦疼。余证同三阳。
（四十）问有发热恶寒。烦躁。手足温而脉反浮紧者。有寒多热少不烦躁。手足微冷而脉反浮
缓者。
此名伤风见寒脉。伤寒见风脉也。盖发热恶风烦躁手足温为中风。候脉浮紧为伤寒脉。是中风
见寒脉
也。寒多热少。不烦躁。手足微厥为伤寒。候脉浮缓为中风脉。是伤寒见风脉也。中风见寒脉。伤
寒见风脉。宜服大青龙汤（正三十五）。盖大青龙证脉似桂枝反无汗。病似麻黄反烦躁是也。（脉弱有汗为桂枝
证。脉紧不烦躁为麻黄证）大青龙汤。治病与麻黄汤证相似。但病尤重而又加烦躁者。用大青龙
汤也。以其中风并伤寒俱盛。故青龙汤添麻黄作六两。又似合桂枝汤药味在内。添石膏所以为紧。
此治营卫俱病。若证不审。误用大青龙汤。则发汗多伤人。（以其有烦躁一证。故可用大青龙汤）
大抵感外风者为伤风。感寒冷者为伤寒。故风则伤卫。寒则伤营。桂枝主伤卫。麻黄主伤营。大青
龙主营卫俱伤故也。风伤卫者。病在皮肤之间也。以卫行脉外。为阳。主外。皮肤之间卫气之道
路故也。其病浅。寒伤营者。寒气中于肌肉也。以营行脉中为阴。主内。肌肉之间。营气之道路故
也。其病深。所以桂枝与麻黄所施各异。戒勿误用。以有浅深之别。风寒之殊。大医当宜审谛。大
青龙尤宜慎用。仲景云。脉微弱汗出恶风者。不可服青龙。服之则厥逆。筋惕肉 。此为逆也。类
纂云。凡发汗过多。筋惕肉 。振摇动人。或虚羸之人。微汗出。便有此证。俱宜服真武汤（正百五）以救之。
羸甚者芍药或量多少与之。恶热药者。去附子。余根据加减法。仲景制真武汤。乃为合用桂枝。却用麻
黄之类。发汗多。亡阳有此证。故用真武汤。若调理顺者。无此证也。
（四十一）问夏月发热恶寒。头疼身体支节痛重。其脉洪盛者。
此名热病也。冬伤于寒。因暑气而发为热病。治热病与伤寒同。有汗宜桂枝汤。（正一）无汗宜麻黄汤。（正二十）
加烦躁者。宜大青龙汤（正三十五）。然夏月药性须带凉。不可太温。桂枝麻黄大青龙须用加减法。夏至前桂枝
加黄芩半两。夏至后桂枝麻黄大青龙加知母一两。石膏二两。或加升麻半两也。盖桂枝麻黄汤性热。
地暖之处。非西北之比。夏月服之。必有发黄斑出之失。热病三日外。与汤不瘥。脉势仍数。邪气
犹在经络。未入脏腑者。桂枝石膏汤主之。（杂三十五）此方夏至后代桂枝证用。若加麻黄半两。可代麻黄青
龙汤用也。古方三月至夏为晚发伤寒。栀子升麻汤。（杂三十六）亦可选用之。○又问夏至后皆可行白虎汤液耶。
白虎汤治中暑与汗后一解表药耳。今之医者。见六月中病。多云中暑。不辨热病。用药大凉。又
况夏月阴气在内。最难调治。白虎汤尤宜戒之。
（四十二）问夏月自汗恶寒。身热而渴。其脉微弱者。
此名中暑也。大抵中暑与热病外证相似。但热病者脉盛。中暑者脉虚。以此别之。甲乙经云。
脉盛身寒。得之伤寒。脉虚身热。得之伤暑。盖寒伤形而不伤气。所以脉盛。热伤气而不伤形。所
以脉虚。伤寒即身体支节痛重。其脉洪盛。按之有力。此是冬月感寒深。至夏发耳。中暑即背寒面
垢。（其面如涂油。类纂云。面垢者阳证也。一名面尘。若尘埃之着面）手足微冷。烦渴口燥。
但觉倦怠。四肢却不痛重。其脉微弱。按之无力。白虎汤主之（正六四）。痰逆恶寒者。橘皮汤主之。（杂四）不恶寒
者。竹叶汤主之。（正九五）头疼恶心烦躁。心下不快者。五苓散（正六六）最妙。○又问中暑何故洒然毛耸恶寒。答曰。
经云。四时八风之中人也。因有寒暑。寒则皮肤急。腠理闭。暑则皮肤缓。腠理开。开则洒然寒。闭
则热而闷。近人多不明中暑。或作热病法治之。复用温热药。必致发黄斑出。更为蓄血。尤宜戒之。
（四十三）问夏至以前。发热恶寒。头疼身体痛。其脉浮紧。
此名温病也。春月伤寒。谓之温病。冬伤于寒。轻者夏至以前发为温病。盖因春温暖之气而发
也。（又非温疫也）治温病与冬月伤寒、夏月热病不同。盖热轻故也。（春初秋末。阳气在里。
其病稍轻。纵不用药治之。五六日亦自安）升麻汤（杂一）、解肌汤（杂三八）、柴胡桂枝汤、（正三一）最良。热多者小
柴胡汤主之。（正二九）不渴外有微热者。小柴胡加桂
枝也。嗽者小柴胡加五味子也。或烦渴发热不恶寒与虚烦者。并竹叶石膏汤（正九五）。次第服之。麻黄桂枝
大青龙。唯西北二方四时行之。无有不验。若江淮间。地偏暖处。唯冬月及正初乃可用正方。自春
末至夏至以前。桂枝麻黄大青龙内宜加减也。（加减法。在热病门）
（四十四）问病患先热后寒。尺寸脉俱盛。
此名温疟也。先热后寒。名曰温疟。病患尺寸俱盛。重感于寒。变成温疟。小柴胡汤主之。（正二九）疟
疾寒热相等。及先热后寒者。俱宜与小柴胡汤。先寒后热者。小柴胡加桂汤。（杂三九）有多热但热者。白虎
加桂汤。（杂四十）有多寒但寒者。柴胡桂姜汤。（杂四一）有汗多烦渴。小便赤涩。素有瘴气。及不服水土。呕吐甚者。
可服五苓散。（正六六）脉小紧。寒热呕吐。间日频日。发作无时。大便秘者。可服大柴胡汤下之。（正三十）脉浮大。
寒热往来者。可服祛邪丸吐之。（杂四三）久不愈者。服疟母煎丸。（杂四二）当自愈。治疟之法。无以过也。○大抵疟
脉自弦。弦数者多热。弦迟者多寒。弦小紧者可下之。弦迟者可温之。弦紧者可发汗。浮者可吐之。
夏伤于暑。秋必病疟。此非伤寒之谓。以其坏伤寒有温疟一证。故因而及之。
（四十五）问脉尺寸俱浮。头疼身热。常自汗出体重。其息必喘。四肢不收。嘿嘿但欲眠。
此名风温也。其人素伤于风。因复伤于热。风热相搏。即发风温。主四肢不收。（左传曰。风
淫末疾）头疼身热。常自汗出不解。治在少阴厥阴。（少阴火。厥阴风）不可发汗。发汗即
谵言。独语。内烦躁扰。不得卧。若惊痫。目乱无精。疗之者。复发其汗。如此死者。医杀之也。
风温不可发汗。宜葳蕤汤。（杂四五）风温身灼热者。知母干葛汤。（杂四六）
风温加渴甚者。栝蒌根汤。（杂四七）风温脉浮身重汗出。汉防己汤。（杂四八）
（四十六）问一岁之中。长幼疾状多相似。
此名温疫也。四时皆有不正之气。春夏亦有寒清时。秋冬或有暄暑时。人感疫厉之气。故一岁
之中。病无长少。率相似者。此则时行之气。俗谓之天行是也。老君神明散（杂四九）、务成子萤火丸、圣散
子（并杂五十）、败毒散。（杂三十三）冬气温。春气寒。夏气冷。秋气热。为时气。时气与伤寒同而治有异者。盖因四
时不正之
气而更改。不拘以日数浅深。汗吐下随证施行。所以圣散子不问表里阴阳者此也。唯圣散子性差热。
用者宜详之。若春应暖而清气折之。则责邪在肝。三四月或有暴寒。其时阳气尚弱。为寒所折。
病热犹轻。升麻散（杂一）解肌汤主之。（杂三十八）夏应暑而寒气折之。则责邪在心。五月六月阳气已盛。为寒所
折。病热则重。七月八月阳气已衰。为寒所折。病热亦微。调中汤（杂五一）、射干汤（杂五二）、半夏桂枝甘草汤（杂
五三）。可选而用之。秋应凉而反大热。抑之则责邪在肺。湿热相搏。民多病瘅。瘅者黄也。宜白虎加苍
术汤。（杂百十七）煎茵陈汁调五苓散。（正六十六）冬应寒而反大温。抑之则责邪在肾。其冬有非节之暖者。名为冬
温。此属春时阳气发于冬时。则伏寒变为温病。宜葳蕤汤。（杂四五）仲景云。冬温之毒。与伤寒大异。盖
伤寒者。伤寒气而作。冬温者。感温气而作。寒疫者。暴寒折人。非触冒之过。其治法不同。所施
寒热温凉之剂亦异。不可拘以日数。发汗吐下。随证施行。要之治热以寒。温而行之。治温以清。
冷而行之。治寒以热。凉而行之。治清以温。热而行之。以平为期。不可以过。此为大法。
（四十七）问一身尽痛。发热身黄。小便不利。大便反快者。
此名中湿也。风雨袭虚。山泽蒸气。人多中湿。湿流关节。须身体烦痛。其脉沉缓为中湿。
（脉细者非也）主一身尽痛。发热身黄。小便自利者。术附汤。（正七十）若小便不利大便反快。当利其小
便。宜甘草附子汤、（正七一）
五苓散（正六六）主之。至真要论云。治湿之法。不利小便，非其治也。金匮要略云。湿家身
烦痛。可与麻黄汤加白术四分。发其汗。慎不可以火攻之。湿家虽身体痛。不可太发汗。汗出则作
。大抵中湿者。水湿之蒸气。及汗出当风。取冷过度。或中雾露与风寒气合者曰痹。皆由中于湿
而后挟以异气。其寒多者为痛。为浮肿。非附子桂术不能去也。其风多者为烦热。为流走。为拘急。非麻黄
薏苡乌头辈不能散也。其中气者为坚满。为癃闭。非甘遂葶苈枳术不能泄也。
（四十八）问支体痛重。不可转侧。额上微汗不欲去被。或身微肿。
此名风湿也。脉浮为风。湿是风气与湿气相搏。肢体痛重。不可转侧。额上微汗不欲去被。或
身微肿。欲发汗。但 身润。则风湿俱去。若大发其汗。则风气去湿气在矣。麻黄杏子薏苡甘草
汤、（杂五四）防己黄 汤、（杂五五）桂枝附子汤（正六九）桂枝加白术汤。甘草附子汤、（正
七一）术附汤、（正七十）杏仁汤、（杂五六）败毒散（杂三十三）可选而用之。身肿者。甘草附子汤
加防风。
This volume discusses the names of Shanghan (Cold Damage), Shangfeng (Wind Strike), Rebing (Heat Disease), Zhongshu (Summerheat Stroke), Wenbing (Warm Disease), Wenmie (Warm Malaria), Fengwen (Wind-Warmth), Wenyi (Warm Epidemic), Zhongshi (Dampness Strike), Shiwen (Damp-Warmth), Zhu disease (Infectious Disease), and Wendu (Warm Toxin).
Regarding affairs in the world, when names are established, realities can be distinguished; when speech is appropriate, affairs can be accomplished. How much more so with the various names of Shanghan (Cold Damage)? If one recognizes their names, even if there are errors in treatment, the efficacy will vary in depth, and the speed of effect will vary in slowness or quickness. Without recognizing the names, reckless treatment often leads to mistaking Zhongshu (Summerheat Stroke) for Rebing (Heat Disease) and wrongly using warm medicines, or mistaking Shiwen (Damp-Warmth) for Fengwen (Wind-Warmth) and adding sweating methods. Confusion of names and realities leads to chaos of right and wrong, endangering life as precariously as a candle in the wind. Now, under each question, I will detail the symptoms and name them as specific diseases, hoping that by knowing the name, one can recognize the disease, and by recognizing the disease, one can identify the syndrome. This is like gaining sight in darkness, making the mind clear, so that treating diseases will not fail.
(Question 38) Pulse is floating, tight, and choppy; headache; body stiffness and urgency; aversion to cold; no sweat; more cold than heat; sallow and unhappy complexion; pain in the lower back and spine; slight coldness in the fingertips of hands and feet; no irritability.
This is named Shanghan (Cold Damage). The signs of Shanghan (Cold Damage) include fever, aversion to cold, headache, pain in the lower back and spine, tight pulse, and no sweat. It should be resolved by inducing sweating, primarily using Mahuang Tang (Ephedra Decoction). For mild cases, only Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Volume Decoction) is given. Other options include Renshen Shunqi San (Ginseng Smooth Qi Powder), Congchi Tang (Scallion and Fermented Soybean Decoction), Cangzhu San (Atractylodes Macrocephala Powder), and Mahuang Gegen Tang (Ephedra and Pueraria Decoction). However, Taiyang disease (Disease of the Bladder and Small Intestine Channels) may also present with more heat than cold; one must carefully examine the pulse and signs. If there is more heat than cold, no vomiting, and normal bowel movements, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Volume Decoction) is suitable. If the pulse is floating, despite more heat than cold, sweating may be induced. If the pulse is weak, it indicates deficiency of Yang; Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Bitter Orange Once Decoction) is primary. If there is more heat than cold and the Chi pulse (Kidney pulse) is slow, it is due to insufficient Ying (Nutritive) Qi and blood. Start with Xiaojianzhong Tang (Minor Construct the Middle Decoction) added with Huangqin (Scutellaria Root); this is best. If the Chi pulse remains slow, administer another dose. Or, if Taiyang signs require sweating but the patient has recently lost blood or suffered diarrhea, frequently give Shaoguizhi Tang (Minor Cinnamon Twig Decoction) until the body becomes moist; after several days, it should resolve spontaneously. For example, patients with Lin disease (Dysuria) or those prone to epistaxis (Nosebleed) should not be sweated according to law; instead, they can use Jiehe (Harmonizing) methods similar to Xiaochaihu Tang (Minor Bupleurum Decoction).
(Question 39) Pulse is floating and moderate; Cun pulse (Lung/Heart pulse) is large and Chi pulse is weak; spontaneous sweating; body heat; headache; aversion to wind; more heat than cold; bright and not sallow complexion; irritability; hands and feet are not cold.
This is named Shangfeng (Wind Strike). The signs of Shangfeng (Wind Strike) include headache, fever, moderate pulse, sweating, and aversion to wind. One must release the muscle layer, primarily using Guizhi Tang (Cinnamon Twig Decoction). For mild cases, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction), Baidu San (Hundred Poisons Powder), or Duhuo San (Angelica Pubescens Powder) can be selected. Treating Taiyang Zhongfeng (Wind Strike on the Taiyang Channel): for sweating, use Guizhi Tang (Cinnamon Twig Decoction). A tight pulse always means no sweat; only if the pulse is soggy and tight with spontaneous sweating should one avoid mistakenly using Xiaojianzhong Tang (Minor Construct the Middle Decoction). Only when the pulse is floating and moderate can Guizhi Tang (Cinnamon Twig Decoction) be used. For stiffness in the neck and back, add Gegen (Kudzu Root) to Guizhi Tang (Cinnamon Twig Decoction). (*Bencao* states Gegen treats Wind Strike with dampness, opens orifices, and releases the muscle layer. Adding Gegen implies Wind Strike with dampness requires removing wind-dampness via slight sweating.) For interior cold, use Guizhi Qu Shaoyao Fu Zi Tang (Cinnamon Twig Decoction without Peony and with Aconite). After sweating, if sweat does not stop, it is called Loufeng (Leaking Wind); Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Added Aconite) is primary. Abdominal fullness belongs to Taiyin syndrome. If the pulse is floating, Guizhi Tang (Cinnamon Twig Decoction) can be used to induce slight sweating. For abdominal pain, use Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony). For severe pain, use Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb). Although Guizhi Tang (Cinnamon Twig Decoction) works effectively year-round for people in the northwest, in the Jianghuai region, it is only suitable for winter and early spring. From late spring to before Summer Solstice, for Guizhi signs, add half liang of Huangqin (Scutellaria Root); this is Yangdan Tang (Yang Dawn Decoction). After Summer Solstice, for Guizhi signs, add one liang of Zhimu (Anemarrhena Rhizome) and two liang of Shigao (Gypsum), or half liang of Shengma (Cimicifuga Rhizome). If the patient is constitutionally deficient and cold, use the ancient formula directly without modifications. (This refers to Qibo's principle of "treating the same disease differently." Generally, warm medicines should be avoided in spring, and hot medicines in summer, as stated in *Suwen*: "Use warmth from warmth, use heat from heat.") Question: How to distinguish Shanghan (Cold Damage) from Shangfeng (Wind Strike)? Shanghan (Cold Damage) has a tight and choppy pulse; Shangfeng (Wind Strike) has a floating and moderate pulse. Shanghan (Cold Damage) has no sweat (due to choppy pulse); Shangfeng (Wind Strike) has sweat. Shanghan (Cold Damage) fears cold but not wind; Shangfeng (Wind Strike) fears wind but not cold. Generally, Taiyang disease presents with floating pulse, fever, aversion to wind, and aversion to cold. Aversion to cold increases without wind; aversion to wind increases with wind. All six channels have Shanghan (Cold Damage) and Shangfeng (Wind Strike), with different signs. Taiyang floating pulse with sweating is Zhongfeng (Wind Strike); tight pulse without sweating is Shanghan (Cold Damage). Yangming hunger is Zhongfeng (Wind Strike); anorexia is Shanghan (Cold Damage). Shaoyang bilateral deafness, red eyes, chest fullness, and irritability is Zhongfeng (Wind Strike); bitter taste, dry throat, and dizziness is Shanghan (Cold Damage). If Yin channel Shangfeng (Wind Strike) has no atypical signs, only limb discomfort and pain remain, consistent with Yang channels.
(Question 40) Fever, aversion to cold, irritability, warm hands and feet, but pulse is floating and tight; or more cold than heat, no irritability, slightly cold hands and feet, but pulse is floating and moderate.
This is named Shangfeng (Wind Strike) showing Han (Cold) pulse, and Shanghan (Cold Damage) showing Feng (Wind) pulse. Fever, aversion to wind, irritability, and warm hands/feet are Zhongfeng (Wind Strike) signs; a floating and tight pulse is Shanghan (Cold Damage) pulse. This is Zhongfeng (Wind Strike) showing Han (Cold) pulse. More cold than heat, no irritability, and slightly cold extremities are Shanghan (Cold Damage) signs; a floating and moderate pulse is Zhongfeng (Wind Strike) pulse. This is Shanghan (Cold Damage) showing Feng (Wind) pulse. For these conditions, Da Qinglong Tang (Great Azure Dragon Decoction) is suitable. Da Qinglong Tang signs resemble Guizhi signs but without sweat, and resemble Mahuang signs but with irritability. (Weak pulse with sweat is Guizhi sign; tight pulse without irritability is Mahuang sign). Da Qinglong Tang treats conditions similar to Mahuang Tang (Ephedra Decoction) but heavier with added irritability. Since both Wind and Cold are excessive, Ephedra is increased to six liang, resembling a combination with Guizhi Tang (Cinnamon Twig Decoction), and Gypsum is added for intensity. This treats simultaneous Ying (Nutritive) and Wei (Defensive) pathology. If signs are not carefully assessed, mistaken use of Da Qinglong Tang (Great Azure Dragon Decoction) causes excessive sweating and injury. (Irritability justifies its use). Generally, external Wind causes Shangfeng (Wind Strike) damaging Wei (Defensive) Qi; Cold causes Shanghan (Cold Damage) damaging Ying (Nutritive) Qi. Guizhi (Cinnamon Twig) treats Wei damage; Mahuang (Ephedra) treats Ying damage; Da Qinglong Tang (Great Azure Dragon Decoction) treats both. Wind damaging Wei affects the skin surface (superficial). Cold damaging Ying enters muscles (deep). Thus, Guizhi and Mahuang are applied differently; caution against error due to depth differences. Da Qinglong Tang (Great Azure Dragon Decoction) must be used cautiously. Zhang Zhongjing said: Those with weak pulse, sweating, and aversion to wind cannot take Qinglong (Azure Dragon) formulas; doing so causes reversal cold, muscle twitching, and tremors, which is adverse. *Leizuan* states: Excessive sweating causing muscle twitching and tremors, or in emaciated patients with slight sweating, requires Zhenwu Tang (True Warrior Decoction). For severe emaciation, reduce Shaoyao (Peony); for those rejecting hot meds, remove Fuzi (Aconite). Zhang Zhongjing created Zhenwu Tang (True Warrior Decoction) for cases where Guizhi was used but Mahuang caused excessive sweating and Yang collapse. If regulation is smooth, this does not occur.
(Question 41) Summer fever, aversion to cold, headache, heavy joint pain, surging pulse.
This is named Rebing (Heat Disease). Winter cold retained, triggered by summer heat, becomes Rebing (Heat Disease). Treatment is similar to Shanghan (Cold Damage): sweating if present (Guizhi Tang/Cinnamon Twig Decoction); no sweating (Mahuang Tang/Ephedra Decoction). With irritability, use Da Qinglong Tang (Great Azure Dragon Decoction). Summer medicines should be cool, not too warm. Modifications are needed for Guizhi, Mahuang, and Da Qinglong Tangs. Before Summer Solstice, add Huangqin (Scutellaria Root) to Guizhi Tang. After Summer Solstice, add Zhimu (Anemarrhena Rhizome) and Shigao (Gypsum) to Guizhi/Mahuang/Da Qinglong Tangs. Guizhi and Mahuang Tangs are hot; southern climates differ from the northwest. Summer use may cause jaundice and macules. If Rebing (Heat Disease) persists beyond three days with rapid pulse and pathogen still in meridians, GuiZhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) is used. This replaces Guizhi signs after Summer Solstice; adding Mahuang allows it to replace Mahuang/Qinglong Tangs. Late-onset Shanghan (Cold Damage) from March to summer can use Zhizi Shengma Tang (Gardenia and Cimicifuga Decoction). Question: Can Baihu Tang (White Tiger Decoction) be used after Summer Solstice? Baihu Tang (White Tiger Decoction) treats Zhongshu (Summerheat Stroke) and post-sweating exterior resolution. Doctors often mistake June illnesses for Zhongshu (Summerheat Stroke) without distinguishing Rebing (Heat Disease), using overly cold medicines. Summer interior Yin makes treatment difficult; Baihu Tang (White Tiger Decoction) requires caution.
(Question 42) Summer spontaneous sweating, aversion to cold, body heat, thirst, weak pulse.
This is named Zhongshu (Summerheat Stroke). Zhongshu (Summerheat Stroke) resembles Rebing (Heat Disease) externally, but Rebing (Heat Disease) has a strong pulse, while Zhongshu (Summerheat Stroke) has a deficient pulse. *Jia Yi Jing* states: Strong pulse with cold body indicates Shanghan (Cold Damage); weak pulse with heat body indicates Shangshu (Summerheat Injury). Cold damages form (pulse strong); Heat damages Qi (pulse weak). Shanghan (Cold Damage) involves heavy joint pain and surging pulse (winter cold manifesting in summer). Zhongshu (Summerheat Stroke) involves back cold, greasy face, slight cold extremities, irritability/thirst/dry mouth, fatigue without limb pain, and weak pulse. Baihu Tang (White Tiger Decoction) is primary. For phlegm reversal with aversion to cold, Jupi Tang (Tangerine Peel Decoction). For no aversion to cold, Zhuye Tang (Bamboo Leaf Decoction). For headache, nausea, irritability, and epigastric discomfort, Wuling San (Five-Ingredient Powder with Poria) is best. Question: Why does Zhongshu (Summerheat Stroke) cause sudden shivering and aversion to cold? The Classics state: Cold tightens skin and closes pores; Heat relaxes skin and opens pores. Open pores cause chills; closed pores cause heat and oppression. Moderns confuse Zhongshu (Summerheat Stroke) with Rebing (Heat Disease) and use warm medicines, causing jaundice and blood stasis; this must be avoided.
(Question 43) Before Summer Solstice: fever, aversion to cold, headache, body pain, floating and tight pulse.
This is named Wenbing (Warm Disease). Spring Shanghan (Cold Damage) is called Wenbing (Warm Disease). Winter cold retained, mild cases manifest as Wenbing (Warm Disease) before Summer Solstice due to spring warmth. Treatment differs from winter Shanghan (Cold Damage) and summer Rebing (Heat Disease) due to lighter heat. Shengma Tang (Cimicifuga Decoction), Jiemi Tang (Release Muscle Decoction), and Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) are best. For more heat, Xiaochaihu Tang (Minor Bupleurum Decoction). For no thirst and slight exterior heat, add Guizhi (Cinnamon Twig). For cough, add Wuweizi (Schisandra Berry). For irritability/thirst/fever/no aversion to cold or empty irritability, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Mahuang, Guizhi, and Da Qinglong Tangs are effective only in the northwest; in warm Jianghuai regions, use original formulas only in winter/early spring. From late spring to Summer Solstice, modify Guizhi/Mahuang/Da Qinglong Tangs (see Rebing section).
(Question 44) Patient first fever then chills; Cun, Guan, and Chi pulses all strong.
This is named Wenmie (Warm Malaria). First fever then chills is Wenmie (Warm Malaria). Strong pulses at all positions plus secondary cold exposure transforms into Wenmie (Warm Malaria). Xiaochaihu Tang (Minor Bupleurum Decoction) is primary. For equal chills/fever or first fever/chills, use Xiaochaihu Tang (Minor Bupleurum Decoction). For first chill/fever, add Guizhi (Cinnamon Twig). For predominant heat, use Baihu Jia Guizhi Tang (White Tiger with Cinnamon Twig Decoction). For predominant cold, use Chaihu Guijiang Tang (Bupleurum and Ginger Decoction). For sweating/thirst/red urine/miasma/acclimatization issues/severe vomiting, use Wuling San (Five-Ingredient Powder with Poria). For small-tight pulse, chills/fever/vomiting, irregular intervals, constipation, use Dachaihu Tang (Major Bupleurum Decoction) to purge. For floating-large pulse, alternating chills/fever, use Quxie Wan (Evil-Expelling Pill) to vomit. For chronic cases, Naimu Jian Wan (Malaria Mother Decoction Pills) should self-resolve. Malaria pulse is naturally Xian (Wiry). Wiry-rapid indicates heat; wiry-slow indicates cold; wiry-small-tight allows purging; wiry-slow allows warming; wiry-tight allows sweating; floating allows vomiting. Summer heat leads to autumn malaria; this is distinct from Shanghan (Cold Damage) but included due to the Wenmie (Warm Malaria) syndrome arising from damaged Shanghan.
(Question 45) Cun, Guan, Chi pulses all floating; headache, body heat, constant spontaneous sweating, heavy body, panting, limbs unable to hold, silent desire to sleep.
This is named Fengwen (Wind-Warmth). Chronic Wind damage compounded by Heat damage causes Fengwen (Wind-Warmth), characterized by limb weakness. Headache, body heat, constant sweating, and unresolved symptoms treat Shaoyin and Jueyin channels. Sweating is forbidden; inducing sweating causes delirium, muttering, internal irritability, insomnia,惊痫 (startle/epilepsy), and blurred vision. Such deaths are physician-induced. Fengwen (Wind-Warmth) should not be sweated. Use Weirui Tang (Jade Ribbon Decoction). For burning heat, use Zhimu Gan'ge Tang (Anemarrhena and Kudzu Decoction). For severe thirst, use Gualougen Tang (Trichosanthes Root Decoction). For floating pulse, heaviness, and sweating, use Han Fangji Tang (Stephania Tetrandra Decoction).
(Question 46) Throughout the year, young and old have similar symptoms.
This is named Wenyi (Warm Epidemic). Incorrect Qi exists in all seasons. People contracting epidemic Qi suffer similar illnesses regardless of age, known as Shixing (Seasonal Progression) or Tianxing (Heavenly Progression). Laojun Shenming San (Lord Lao's Divine Clarity Powder), Wuchengzi Yinghuo Wan (Firefly Pill), Shengsanzi (Holy Scattered Seed Powder), and Baidu San (Hundred Poisons Powder) are used. Seasonal anomalies (warm winter, cold spring, etc.) create Shiqi (Seasonal Qi). Treatment differs from Shanghan (Cold Damage) based on seasonal incorrect Qi, applying sweating, vomiting, or purging as indicated. Shengsanzi (Holy Scattered Seed Powder) works regardless of exterior/interior or Yin/Yang but is hot; use with caution. Spring cold injury affecting Liver uses Shengma San (Cimicifuga Powder) or Jiemi Tang (Release Muscle Decoction). Summer cold injury affecting Heart uses Tiaozhong Tang (Regulate Middle Decoction), Shegan Tang (Belamcanda Decoction), or Banxia Guizhi Gancao Tang (Pinellia, Cinnamon Twig, Licorice Decoction). Autumn heat affecting Lung (damp-heat jaundice) uses Baihu Jia Cangzhu Tang (White Tiger with Atractylodes Macrocephala Decoction) or Yinchen mixed with Wuling San (Five-Ingredient Powder with Poria). Winter warmth affecting Kidney is Dongwen (Winter Warmth), transforming latent cold into Wenbing (Warm Disease); use Weirui Tang (Jade Ribbon Decoction). Zhang Zhongjing states Dongwen (Winter Warmth) differs from Shanghan (Cold Damage). Dongwen (Winter Warmth) arises from Warm Qi; Han Yi (Cold Epidemic) from violent cold. Treatments vary. General rule: Treat heat with cold (administer warm); treat warmth with cool (administer cold); treat cold with hot (administer cool); treat cool with warm (administer hot). Balance is key; do not overdo.
(Question 47) Whole body pain, fever, yellow skin, difficult urination, loose stools.
This is named Zhongshi (Dampness Strike). Wind/rain attacking deficiency, mountain/mist vapors cause Zhongshi (Dampness Strike). Dampness flows into joints causing painful body, sinking-moderate pulse. For whole body pain, fever, yellow skin, and free urination, Shu Fu Tang (Atractylodes and Aconite Decoction). For difficult urination and loose stools, promote urination with Gancao Fuzi Tang (Licorice and Aconite Decoction) or Wuling San (Five-Ingredient Powder with Poria). *Zhizheng Yaolun* states treating dampness requires promoting urination. *Jingui Yaolue* states for dampness body pain, use Mahuang Tang (Ephedra Decoction) plus Baizhu (Atractylodes Macrocephala) to sweat; avoid fire therapy. Do not sweat excessively. Zhongshi (Dampness Strike) combined with wind/cold/mist causes Bi (Obstruction) syndromes. Cold-dominant causes pain/edema (needs Aconite/Cinnamon/Atractylodes); Wind-dominant causes heat/wandering/spasm (needs Ephedra/Hemp Seed/Aconite); Qi-stagnant causes fullness/retention (needs Kansui/Descurainia/Zhi Zhu).
(Question 48) Limb pain/heaviness, inability to turn, slight forehead sweat, desire to keep covers, or slight swelling.
This is named Fengshi (Wind-Dampness). Floating pulse indicates Wind; Dampness combines with Wind. Symptoms include limb pain/heaviness, inability to turn, slight forehead sweat, desire for covers, or slight swelling. Induce sweating until body is moist to resolve both Wind and Damp. Excessive sweating removes Wind but retains Damp. Options include Mahuang Xingzi Yiyi Gancao Tang (Ephedra, Apricot Kernel, Coix Seed, Licorice Decoction), Fangji Huangqi Tang (Stephania and Astragalus Decoction), Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction), Guizhi Jia Baizhu Tang (Cinnamon Twig plus Atractylodes Macrocephala Decoction), Gancao Fuzi Tang (Licorice and Aconite Decoction), Shu Fu Tang (Atractylodes and Aconite Decoction), Xingren Tang (Apricot Kernel Decoction), and Baidu San (Hundred Poisons Powder). For swelling, add Fangfeng (Saposhnikovia Root) to Gancao Fuzi Tang (Licorice and Aconite Decoction).