（伤寒 中寒 瘟疫大头病附 内伤脾胃附）
脉 人迎脉必紧盛。或浮或紧。无汗。太阳尺寸俱浮。阳明尺寸俱长。少阳尺寸俱弦。太阴
尺寸俱沉细。少阴尺寸俱沉。厥阴尺寸俱微缓。又浮大。属阳。沉细属阴。伤寒热盛。脉
大者生。沉小者死。已汗。沉小者生。浮大者死。脉诀云。阴阳俱盛。重感于寒。变为温疟
。阳脉浮滑。阴脉濡弱。更遇于风。变为风湿。阳脉洪数。阴脉实大。更遇湿热。变为湿毒
。病发热。脉沉细。表得太阳。名曰 。（ 有刚柔二种、有汗名柔 、无汗名刚 、）病太阳
。关节即痛而烦。脉沉。名曰湿痹病太阳。身热疼痛。名曰中 。病。发汗身内热。名曰风
温。其症脉阴阳俱浮。自汗身重多眠。小便不利。
症 谨按内经曰。凡伤于寒者。则为病热。热虽甚。不死。若两感于寒而病者。必死。尺寸
俱浮者。太阳受病也。当一二日发。以其脉上连风府。故头项痛。腰脊强也。尺寸俱长者。
阳明受病也。当二三日发。以其脉挟鼻。络于目。故身热。目疼。鼻干。不得卧。尺寸俱弦
者。少阳受病也。当三四日发。以其脉循胁。络于耳。故胸胁痛而耳聋。此三阳经受病。未
入于府者。可汗而已。尺寸俱沉细者。太阴受病也。当四五日发。以其脉布胃中。络于嗌。
故腹满而嗌干。尺寸俱沉者。少阴受病也。当五六日发。以其脉贯肾。络于肺。系舌本。故
口燥舌干而渴。尺寸俱微缓者。厥阴受病也。当六七日发。以其脉循阴器。络于肝。故烦满
而囊缩。此三阴经皆受病。已入于府。可下而已。若更感异气变为他病。当依旧坏症病而治
之。若两感于寒者。一日太阳受之即与少阴俱病。则头痛口干。烦满而渴。二日阳明受之。
即与大阴俱病。则腹满身热。不欲食。谵语。三日少阳受之。即与厥阴俱病。则耳聋囊缩而
厥。水浆不入。不知人者。六日死。若三阴三阳五脏六腑皆受病。则荣卫不行。脏腑不通。
即死矣。
又按仲景伤寒论曰。冬气严寒。万类潜藏。君子当固密。则不伤于寒。触冒之者。乃名伤寒
耳。其伤于四时之气者。皆能为病。以伤寒为毒者。以其最为杀疠之气也。自霜降后。至春
分前。感寒而即病者。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
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。若春时应暖而反
寒。夏时应热而反凉。秋应凉而反热。冬应寒而反温。此非其时而有其气。是以一岁之中。
长幼之病。多相似者。此则时行之气也。若天令温暖而感之。是为冬温。如春时天令温暖而
壮热为病者。乃温病也。如天气尚寒。冰雪未解。感寒而病者。亦曰伤寒。若春末夏秋之间
。天气暴寒。而感之为病者。此乃时行寒疫也。如夏至后，壮热脉洪者。谓之热病也。然又
有温疟。风温。温毒。温疫。中寒。中风。伤风。中湿。中暑。中 。湿毒。湿温。痰症。
脚风。内伤。食积。虚烦。阴虚阳乏。亦皆发热。状似伤寒。故世俗不辨。悉以伤寒治之。
杀人多矣。且温病热病。乃因伏寒而变。既变。不得复言为寒也。其寒疫。乃天之暴寒。与
冬时严寒。又有轻重不同。时气是天行疫疠之气。又非寒比也。温病乃山泽蒸气。暑乃炎日
之火。风乃天之贼邪。皆伤于人者也。有中者为重。伤者犹轻也。温疟。风温。又系伤寒坏
症。更感异气所变。治亦不同。且诸症似伤寒者。各有其因。岂可通谓伤寒而混治之耶。且
名不正。则言不顺。名尚不正。岂可以言治乎。幸东垣发内外伤辨之论。救千古无穷之弊。
其功盛已哉。
又按东垣内外伤辨曰。夫伤寒者。其寒邪多伤于太阳之经。而后传变。故先头疼身痛而发热
。其脉见于左手。人迎脉必紧盛。或浮紧而无汗。其寒热齐作而无间。晡时必剧。乃邪气盛
。潮作之时。精神有余。语言壮厉。口鼻之气俱盛。手背热而手心不热。乃邪气胜此为有余
。当泻不当补也。内伤则见于右手。气口脉必紧盛。手心热而手背不热。燥作寒已不相并。
但有间耳。日晡时必减。乃胃气得令。潮作之时。精神困倦。少气懒语。身无大热。脉不紧
数。但大而无力。是阳气自伤。不能升达。降下阴分而为内热。是阳虚也。此为不足。宜补
不宜泻也。若劳心好色。内伤真阴。阴血既伤。则阳气偏胜而变为火矣。是为阴虚火动。或
盗汗遗精。咳嗽寒热。或于午后发热。身无痛处。惟觉困倦。其脉细数无力。宜补阴降火。
伤食者。因饮食停滞而发热。气口脉亦紧盛。或右关短滑。太抵伤食则恶食。理必然也。又
或噫气吞酸。或恶食气。或欲吐不吐。或恶心痞闷。按之则痛。或胃口作疼。或停食而复感
寒者。则气口人迎之脉俱大也。亦头痛发热。恶寒拘急。中脘痞闷。或吐或呕。或痛者。为
伤食也。若发热脉浮缓而有汗者。谓之伤风也。必口气粗。合口不开。面光不惨。恶风不恶
寒也。虚烦者。谓虚热。心中郁郁不安。故谓之烦。但只不恶寒。头身不痛。脉不紧数。此
为异耳。痰症者。乃停痰留饮。凝结中脘。亦令人寒热。状如伤寒。若痰在上焦。则寸沉滑
。或沉伏。痰在中焦。则右关滑大。兼气郁。则沉而滑。挟食则短而滑也。凡关脉滑大者。
膈上有痰。可吐之。香港脚之症。亦发寒热。或呕逆。或举体转筋。足胫 赤而肿者。是有瘀
血。症为跌扑损伤。初时不觉。过七八日或十余日。则寒热始作。但胁下及小腹必疼。手不
可近。若血上冲。而昏迷不省。良久复苏。此瘀血也。温病者春时地天道和暖。若壮热烦渴而
不恶寒者。温病也。若夏至以后。时令炎暑。患壮热烦渴而不恶寒者。热病也。时气乃天行
温疫。四时不正之气。人感之。则长幼一般病也。亦与伤寒相似。盖伤寒因寒而得之。此乃
瘟疫之气。不可与伤寒同论也。寒疫者。乃天之暴寒为病。四时之中。或有风寒之作。感而
即病者。寒疫也。亦与伤寒相似。但略轻耳。冬温者。因冬时有非节之暖。实时行之气也。
若发斑者。亦曰温毒也。中 。即中热也。盖伤大阳经与伤寒相似。故曰中 。必汗出身热
而渴。或身重而疼也。中暑者。热伤于心脾之经。而不在大阳。其候面垢。自汗。身热。烦
渴。脉虚。或背微寒。盖暑喜伤心。心不受邪。则包络受之。包络本相火也。以火助火。故
热甚而昏也。或小便不利。或呕吐头疼。胸膈痞满。或腹痛。又有伤暑之症。虽属外感。却
类内伤。与伤寒大异。盖寒伤形。寒邪客表。有余之症。故宜汗之。暑伤气。元气为热所伤
而耗散。乃不足之症。故宜补之。东垣所谓清暑益气是也。又有因时暑热。而过食冷物以伤
其内过取凉风以伤其外。此则非暑伤人。乃因暑而自致之病。宜辛热解表。或辛温理中之剂
。却与伤寒治法相类者也。风湿者。春夏之交。病如伤寒。肢体重痛。转侧则难。小便不利
。因阴雨毕湿。或引饮多。有此症。宜五苓利之忌汗下。有疮疡者。凡疮疡初生。必寒热交
作。必须视其身体有无疮头。仔细详辨。不可便作伤寒治之。凡脉浮数。当发热而漉浙恶寒
。若饮食如常。而有痛处。必生恶疮。常见俗医。妄名流注。伤寒褊考诸书。并无此名。何
其谬哉。凡此之类外形相似。内实不同。治法多端。不可或谬。必须审其果为温病。热病。
及温疫也。则用河间法。果为气虚。伤食。及内伤也。则用东垣法。果为阴虚。及痰火也。
则用丹溪法。果为正伤寒例病也。则遵用仲景法。如此则庶无差误以害人性命矣。世俗但见
发热之症。一概认作伤寒治之。悉用汗药以发其表。汗后不解。遽用下药以疏其里。设是虚
症。岂不死哉。故经曰实实虚虚。损不足而益有余。如此死者。医杀之耳。仁者鉴此。岂不
痛欤。
治 愚考仲景治伤寒。着三百九十七法。一百一十三方。然究其大要。无出乎表里虚实。阴
阳寒热。八者而已。若能明究其的。则三百九十七法。了然于胸中也。何以言之。有表实。
有表虚。有里实。有里虚。有表里俱实。有表里俱虚。有表寒里热。有表热里寒。有表里俱
热。有表里俱寒。有阴症。有阳症。病各不同。要辨明而治之。其脉浮紧。发热恶寒。身疼
而无汗者。表实也。宜麻黄汤以汗之。若脉浮缓。发热恶风。身疼而有汗者。表虚也。宜
桂枝汤以和之。设腹中鞭满。大便不通。谵语潮热。脉实者。里实也。宜大柴胡大小承气之
类。看虚实下之。或腹鸣自利。有寒有热者。里虚也。如表里俱实者。内外皆热也。脉浮洪
。身疼无汗。宜防风通圣散汗之。若口渴饮水。舌燥脉滑者。人参白虎主之。若弦大而滑者
。小柴胡合白虎主之。如表里俱虚。自汗自利者。宜人参三白汤。或黄 建中汤。加人参白
术主之。脉微细。足冷者。加附子以温之。如表寒里热。身寒厥冷。脉滑数。口燥渴。白虎
汤主之。如里寒表热者。面赤。烦躁。身热。自利清谷。脉沉者。以四逆汤温之。如表里俱
寒。而自利清谷。身疼恶者。此内外皆寒也。先以四逆救里。后以桂枝治表。如阴症发热。
则脉洪数而爆渴矣。大抵麻黄桂枝之类。汗而发之。葛根升麻之类因其轻而扬之。承气陷胸
之类。引而竭之。泻心十枣之类。因中满而泄之。在表者汗之。在里者下之。半表半里者和
之。表多里少者。和而少汗之。里多表少者。和而微下之。在上者吐之。中气虚而脉微者温
之。全在活法以施治也。若表里汗下之法。一或未当。则死生系反掌之间。可不深思而明辨
哉。
按陶氏伤寒启蒙云。发热恶寒。头项痛。腰脊强。则知病在太阳经也。身热。目痛。鼻干。
不得眠。则知病在阳明经也。胸胁痛。耳聋。口苦。舌干。往来寒热而呕。则知病在少阳经
也。腹满。咽干。手足温。或自利。不渴。或腹满时痛。则知病在太阴经也。引衣倦卧。恶
寒。或舌干口燥。则知病在少阴经也。烦满囊缩。则知病在厥阴经也。潮热自汗。谵语发渴
。不恶寒。反恶热。揭去衣被。扬手掷足。或发斑黄。狂乱。五六日不大便。则知病在正阳
明胃府也。设若脉症不明。误用麻黄。令人汗多卞阳。误用承气。令人大便不禁。误用姜附
。令人失血发狂。正为寒凉耗其胃气。辛热损其汗液。燥热助其邪热。庸俗狐疑。莫此为甚
。盖伤寒之邪。实无定体。或入阳经气分。则太阳为首。其脉必浮。或入阴经血分则少阴为
先。其脉必沉。浮而有力无力。是知表之虚实。沉而有力无力。是知里之虚实。中而有力无
力。是知表里缓急。脉有浮沉虚实。症乃传变不常。全在活法二字。不可拘于日数。但见太
阳症。在直攻太阳。但见少阴症。在直攻少阴。但见真寒。直救真寒。见此三症。便作主张
。不必悉具。当知如何处治。此为活法。若同而异者明之。似是而非者辨之。在表者。汗
之。散之。在里者。下之。利之。在上者。因而越之。陷下者。升而举之。从乎中者和解之
。直中阴经者温补之。若解不开。不可攻里。日数虽多。但有表症而脉浮者。尚宜发散此事
不明。攻之为逆。经云。一逆尚引日。再逆促命期。若表症解而里症具者。不可攻表。日数
虽少。但有里热症而弦实者。急当下之。此事不明。祸如反掌。经云。邪热未除。复加燥热
。犹抱薪积火矣。如直中阴经真寒症。无热恶寒。不渴。只宜温补。切禁寒凉之药。此事不
明。杀人甚速。经云。非从无益。而反害之。阴症似阳者。温之。阳症似阴者。下之。阳
毒者。分轻重下之。阴毒者。分缓急温之。阳狂者。下之。阴厥者。温之。湿热发黄者。利
之。下之。血症发黄者。溃之。下之。谵语者。下之。温之。中满者。消之。泻之。结胸者
。解之。下之。太阳症以少阴者。温之。少阴症似太阳者。汗之。衄血者。解之。止之。发
喘者。汗之。下之。咳嗽者。利之。解之。正伤寒者。大汗之。大下之。感寒或冒寒者。微
汗之。微下之。劳力感寒者。温散之。温极病者。微解之。大下之。此经常之大法也。有病
一经已用热药。而又用寒药如少阴症用白虎汤四逆散寒药者。又少阴用四逆汤真武汤热药
者。庸俗狐疑。拒能措手哉。呜呼。能发伤寒之症名。而得伤寒之方脉。如此视切。乃为良
医。始在寒药如少阴。乃传经热症也。热药治少阴。乃直中阴经。真寒症也。辨名定经。明
脉识症。验症用药。真知在表而汗。真知在里而下。真知直中阴经而温。如此而汗。如彼而
下。又如彼而温。辛热之剂。投之不瘥。寒凉之药。用之必当。病奚逃乎。须分轻重缓急。
老少虚实。久病新发。妇人胎产。室女经水。大凡有胎产伤寒。不与男子伤寒同治法。无胎
产者治相同。妇人经水适来适断。即是热入血室。但宜和解表里。久病者过经不解。坏症也
。新发者。始病也。老者血气衰。少者血气壮。缓者病之轻。急者病之重。寒药热服。热药
(Shanghan [Cold Damage], Zhonghan [Mid-Cold], Plague and Big Head Disease Appendix, Internal Injury to Spleen and Stomach Appendix)
Pulse: The Renying pulse (Renying acupoint pulse, located on the carotid artery) must be tight and vigorous. It may be floating or tight. There is no sweating. The Cun and Chi positions of the Taiyang channel are both floating. The Cun and Chi positions of the Yangming channel are both long. The Cun and Chi positions of the Shaoyang channel are both wiry. The Cun and Chi positions of the Taiyin channel are both deep and fine. The Cun and Chi positions of the Shaoyin channel are both deep. The Cun and Chi positions of the Jueyin channel are both slightly slow and mild. Additionally, a floating and large pulse indicates a Yang pattern; a deep and fine pulse indicates a Yin pattern. In Shanghan with intense heat, a large pulse indicates survival, while a deep and small pulse indicates death. After sweating has occurred, a deep and small pulse indicates survival, while a floating and large pulse indicates death. The *Maijue* (Pulse Classic) states: When both Yin and Yang pulses are vigorous, and cold is contracted again, it transforms into Wen Nue (Warm Malaria). If the Yang pulse is floating and slippery, and the Yin pulse is soft and weak, and wind is encountered again, it transforms into Wind-Dampness. If the Yang pulse is surging and rapid, and the Yin pulse is solid and large, and damp-heat is encountered again, it transforms into Damp-Toxin. If the disease presents with fever and a deep-fine pulse, and the exterior syndrome belongs to the Taiyang channel, it is named Rou Jing (Soft Spasm). (Rou Jing has two types: rigid and soft; with sweating it is called Soft, without sweating it is called Rigid.) If the disease is in the Taiyang channel, joint pain occurs accompanied by irritability, and the pulse is deep, it is named Shi Bi (Damp-Bi Syndrome). If the disease is in the Taiyang channel, with body heat and pain, it is named Zhong Yue (Heat Stroke/Heat Apoplexy). If sweating leads to internal heat, it is named Feng Wen (Wind-Warmth). Its symptoms include both Yin and Yang pulses being floating, spontaneous sweating, heaviness of the body, excessive sleepiness, and difficult urination.
Symptoms: According to the *Neijing* (Inner Canon): Generally, contracting cold pathogens results in heat diseases. Even if the heat is severe, it is not fatal. However, if one contracts cold on two levels simultaneously (Liang Gan), death is certain. If the Cun and Chi pulses are both floating, the Taiyang channel is affected, and onset should occur on the first or second day. Because the Taiyang channel connects to the Fengfu point (DU16), headache, neck stiffness, and lumbar spine rigidity occur. If the Cun and Chi pulses are both long, the Yangming channel is affected, and onset should occur on the second or third day. Because the Yangming channel runs alongside the nose and connects to the eyes, body heat, eye pain, nasal dryness, and inability to lie down occur. If the Cun and Chi pulses are both wiry, the Shaoyang channel is affected, and onset should occur on the third or fourth day. Because the Shaoyang channel follows the hypochondrium and connects to the ears, chest and hypochondriac pain and deafness occur. For these three Yang channels, if the pathogen has not entered the Fu organs, it can be cured by inducing sweating. If the Cun and Chi pulses are both deep and fine, the Taiyin channel is affected, and onset should occur on the fourth or fifth day. Because the Taiyin channel spreads in the stomach and connects to the pharynx, abdominal fullness and pharyngeal dryness occur. If the Cun and Chi pulses are both deep, the Shaoyin channel is affected, and onset should occur on the fifth or sixth day. Because the Shaoyin channel penetrates the Kidney, connects to the Lung, and ties to the root of the tongue, dry mouth, dry tongue, and thirst occur. If the Cun and Chi pulses are both slightly slow and mild, the Jueyin channel is affected, and onset should occur on the sixth or seventh day. Because the Jueyin channel follows the genitalia and connects to the Liver, irritability, abdominal fullness, and contraction of the scrotum occur. For these three Yin channels, if the pathogen has entered the Fu organs, it can be cured by purging. If another pathogen is contracted subsequently, transforming it into another disease, treatment should follow the principles for damaged syndromes. If one contracts cold on two levels simultaneously, on the first day the Taiyang channel is affected, and simultaneously the Shaoyin channel is affected, resulting in headache, dry mouth, irritability, abdominal fullness, and thirst. On the second day, the Yangming channel is affected, and simultaneously the Taiyin channel is affected, resulting in abdominal fullness, body heat, anorexia, and delirious speech. On the third day, the Shaoyang channel is affected, and simultaneously the Jueyin channel is affected, resulting in deafness, scrotal contraction, and cold limbs. If food and fluids cannot be taken in, and consciousness is lost, death occurs on the sixth day. If all three Yin and three Yang channels, as well as the five Zang and six Fu organs, are affected, the Ying and Wei Qi cease to circulate, and the Zang and Fu organs become blocked, leading to death.
Furthermore, according to Zhang Zhongjing's *Shanghan Lun*: In winter, the air is bitterly cold, and all things hide. A gentleman should keep his pores closed and secure, thus avoiding cold injury. Those who expose themselves to the cold are said to have contracted Shanghan. Contracting the Qi of the four seasons can cause disease. Shanghan is considered the most toxic because it is the most lethal pathogenic factor. From after Frost Descent until before Spring Equinox, contracting cold and immediately falling ill is called Shanghan. If illness does not occur immediately, the cold toxin hides in the skin and muscles, transforming into Wen Bing (Warm Disease) in spring, and Shu Bing (Summer Heat Disease) in summer. Therefore, hardworking people often suffer from warm-heat diseases in spring and summer, caused by contracting cold in winter, not by the Qi of the season. If spring should be warm but is 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. Thus, throughout the year, illnesses among young and old are similar; this is the Qi of the Season (Shi Xing). If warmth arrives out of season and causes illness, it is Dong Wen (Winter Warmth). If spring weather is warm and causes high fever, it is Wen Bing. If the weather is still cold, ice and snow have not melted, and contracting cold causes illness, it is also called Shanghan. If between late spring and early/mid-autumn, sudden cold weather causes illness, this is Shi Xing Han Yi (Seasonal Cold Epidemic). If after Summer Solstice, high fever and a surging pulse occur, it is called Re Bing (Heat Disease). However, there are also Wen Nue, Feng Wen, Wen Du, Wen Yi, Zhong Han, Zhong Feng, Shang Feng, Zhong Shi, Zhong Shu, Zhong Yue, Shi Du, Shi Wen, Tan Zheng, Jiao Feng, Nei Shang, Shi Ji, Xu Fan, Yin Xu Yang Fa, etc., all presenting with fever resembling Shanghan. Thus, laypeople fail to distinguish them and treat them all as Shanghan, causing many deaths. Moreover, Wen Bing and Re Bing arise from latent cold transforming; once transformed, they can no longer be described as cold. Han Yi is sudden cold from heaven, differing in severity from the bitter cold of winter. Shi Qi is the epidemic Qi of heaven and earth, distinct from cold. Wen Bing is vapor from mountains and marshes; Shu is the fire of the blazing sun; Feng is the thief evil of heaven; all injure humans. Direct contraction is severe, indirect injury is lighter. Wen Nue and Feng Wen are damaged syndromes from Shanghan, transformed by contracting other pathogens, requiring different treatments. All syndromes resembling Shanghan have specific causes; how can they be generally termed Shanghan and treated indiscriminately? If names are incorrect, words do not flow smoothly. If names are not correct, how can treatment be discussed? Fortunately, Li Dongyuan published his theory on distinguishing internal and external injuries, saving humanity from endless errors for millennia. His merit is great.
Furthermore, according to Li Dongyuan's *Internal and External Injury Differentiation*: In Shanghan, cold pathogens mostly injure the Taiyang channel first, then transmit. Thus, headache, body pain, and fever appear first. The pulse appears on the left hand; the Renying pulse is tight and vigorous, either floating-tight without sweat. Chills and fever occur simultaneously without interval, worsening at dusk (Bushi), indicating excess pathogenic Qi. During tidal fever, spirit is abundant, speech is loud and fierce, breath from mouth and nose is strong, back of hand is hot while palm is not. This is pathogenic excess, an excess pattern, requiring draining rather than tonifying. Internal injury manifests on the right hand; the Qikou pulse is tight and vigorous. Palm is hot while back of hand is not. Dryness and cold do not occur together, only intermittently. Worsening decreases at dusk, indicating Stomach Qi is commanding. During tidal fever, spirit is fatigued, short of breath, reluctant to speak, body has little heat, pulse is not tight-rapid but large and forceless. This is self-injury of Yang Qi, failing to ascend, sinking into Yin to create internal heat, indicating Yang deficiency. This is a deficiency pattern, requiring tonification rather than draining. If mental labor and sexual indulgence injure True Yin, and Yin Blood is damaged, Yang Qi becomes relatively excessive and transforms into Fire, called Yin Deficiency with Fire Movement. Symptoms may include night sweats, seminal emission, cough with chills and fever, or afternoon fever, without body pain, only fatigue. Pulse is fine, rapid, and forceless. Treatment should tonify Yin and descend Fire. Food stagnation causes fever due to dietary retention; the Qikou pulse is also tight and vigorous, or the Right Guan position is short and slippery. Generally, food stagnation causes aversion to food. Other symptoms include belching with acid regurgitation, aversion to food odors, desire to vomit but unable, nausea and epigastric fullness, pain upon pressure, or stomach ache. If food stagnation is followed by cold contraction, both Qikou and Renying pulses become large, accompanied by headache, fever, aversion to cold, and stiffness. Epigastric fullness, vomiting, or pain indicate food stagnation. If fever presents with a floating-slow pulse and sweating, it is called Shang Feng (Wind Injury). Breath is coarse, mouth remains closed, face is bright not dull, aversion to wind not cold. Xu Fan (Deficiency Irritability) refers to deficient heat, with inner restlessness, hence "Fan". There is no aversion to cold, no head/body pain, and pulse is not tight-rapid. This distinguishes it. Tan Zheng (Phlegm Syndrome) involves retained phlegm and fluid congealing in the Middle Jiao, causing chills and fever resembling Shanghan. If phlegm is in the Upper Jiao, the Cun pulse is deep-slippery or deep-hidden. If in the Middle Jiao, the Right Guan pulse is slippery-large. With Qi stagnation, it is deep-slippery; with food retention, it is short-slippery. If Guan pulses are slippery-large, phlegm is above the diaphragm, treat with emesis. Jiao Feng (Foot Wind/Gout) also presents with chills and fever, or vomiting/reversal, or whole-body spasms. Red and swollen shins indicate blood stasis. Due to trauma, initially unnoticed, after 7-8 or 10+ days, chills and fever begin. Pain in hypochondrium and lower abdomen, intolerable to touch. If blood rushes upward causing coma, recovering after a while, this is blood stasis. Wen Bing: In spring, earth Qi is warm. High fever, irritability, thirst, without aversion to cold, is Wen Bing. After Summer Solstice, in hot weather, high fever, irritability, thirst, without aversion to cold, is Re Bing. Shi Qi is heavenly epidemic warmth, abnormal Qi of four seasons. Contracting it causes illness in young and old alike. It resembles Shanghan, but Shanghan is due to cold, whereas this is plague Qi, not comparable to Shanghan. Han Yi is sudden cold from heaven causing illness in any season. Resembles Shanghan but is milder. Dong Wen is due to unseasonal warmth in winter, part of Shi Xing Qi. If macules appear, it is also called Wen Du. Zhong Yue is Zhong Re (Mid-Heat). Injuring the Taiyang channel resembles Shanghan, hence Zhong Yue. Sweating, body heat, and thirst occur, or heaviness and pain. Zhong Shu (Mid-Summer Heat) injures the Heart and Spleen channels, not Taiyang. Signs include dirty complexion, spontaneous sweating, body heat, irritability/thirst, deflexed pulse, or slight cold on the back. Summer Heat favors the Heart; if Heart does not accept evil, the Pericardium accepts it. Pericardium is Ministerial Fire; fire aiding fire causes extreme heat and coma. Symptoms may include difficult urination, vomiting/headache, chest/diaphragm fullness, or abdominal pain. Shu Shang (Summer Heat Injury) is external but resembles internal injury, very different from Shanghan. Cold injures Form, lodging in the exterior, an excess pattern, so sweating is indicated. Summer Heat injures Qi, Yuan Qi consumed by heat, a deficiency pattern, so tonification is indicated. This is Li Dongyuan's Qing Shu Yi Qi principle. Also, due to summer heat, overeating cold damages the interior, seeking cool wind damages the exterior. This is not Summer Heat injuring man, but self-inflicted due to Summer Heat. Treat with acrid-hot exterior-resolving or acrid-warm Middle-regulating formulas, similar to Shanghan treatment. Feng Shi (Wind-Damp): In spring/summer transition, illness resembles Shanghan, heavy/painful limbs, difficulty turning, difficult urination, due to rainy dampness or excessive drinking. Treat with Wu Ling San to promote urination; avoid sweating and purging. Chu Yang (Sores and Ulcers): Initially, chills and fever alternate. Examine for sore heads. Do not treat as Shanghan. Floating-rapid pulse, fever, chattering chills, normal diet, but painful area indicates malignant sore. Vulgar doctors wrongly name it Liu Zhu (Flowing Node); *Shanghan Bian Kao* books have no such name. How erroneous! Exterior looks similar, interior is different; treatments vary greatly. Must determine if it is Wen Bing, Re Bing, or Wen Yi, then use Hejian's method. If Qi deficiency, food stagnation, or internal injury, use Dongyuan's method. If Yin deficiency or Phlegm-Fire, use Danxi's method. If true Shanghan, follow Zhongjing's method. Thus, few errors harming life. Laypeople see fever, assume Shanghan, use sweating herbs. If unresolved, use purgatives. If deficiency, death ensues. Scripture says: Reinforce excess, drain deficiency, damage the insufficient, benefit the surplus. Such deaths are physician-killed. Benevolent ones, reflect on this, is it not painful?
Treatment: I examined Zhongjing's treatment of Shanghan: 397 methods, 113 formulas. The essence lies in Exterior, Interior, Deficiency, Excess, Yin, Yang, Cold, Heat—eight categories. Understanding these makes the 397 methods clear. Why? Exterior Excess, Exterior Deficiency, Interior Excess, Interior Deficiency, Exterior/Interior Both Excess, Exterior/Interior Both Deficiency, Exterior Cold/Interior Heat, Exterior Heat/Interior Cold, Exterior/Interior Both Heat, Exterior/Interior Both Cold, Yin Syndrome, Yang Syndrome. Diseases differ; distinguish and treat. Floating-tight pulse, fever, aversion to cold, body pain, no sweat: Exterior Excess. Use Ma Huang Tang to sweat. Floating-slow pulse, fever, aversion to wind, body pain, sweat: Exterior Deficiency. Use Gui Zhi Tang to harmonize. Abdominal hardness/fullness, constipation, delirium, tidal fever, solid pulse: Interior Excess. Use Da Chai Hu Tang or Da/Xiao Cheng Qi Tang, purge based on deficiency/excess. Bowel sounds, spontaneous diarrhea, cold/heat mixed: Interior Deficiency. Exterior/Interior Both Excess: Internal/external heat, floating-surge pulse, body pain, no sweat. Use Fang Feng Tong Sheng San to sweat. Thirst, drinking water, dry tongue, slippery pulse: Ren Shen Bai Hu Tang. Wiry-large-slippery pulse: Xiao Chai Hu Tang combined with Bai Hu Tang. Exterior/Interior Both Deficiency: Spontaneous sweat/diarrhea. Use Ren Shen San Bai Tang or Huang Qi Jian Zhong Tang, add Ren Shen, Bai Zhu. Fine-micro pulse, cold feet: Add Fu Zi to warm. Exterior Cold/Interior Heat: Body cold, cold limbs, slippery-rapid pulse, dry mouth/thirst. Bai Hu Tang. Interior Cold/Exterior Heat: Red face, irritability, body heat, spontaneous diarrhea with undigested food, deep pulse. Si Ni Tang to warm. Exterior/Interior Both Cold: Spontaneous diarrhea with undigested food, body pain, aversion to cold. Internal/external cold. First Si Ni Tang to save Interior, then Gui Zhi Tang to treat Exterior. Yin Syndrome with fever: Surging-rapid pulse, violent thirst. Generally, Ma Huang/Gui Zhi type: sweat and release. Ge Gen/Sheng Ma type: lift and disperse due to lightness. Cheng Qi/Xian Xiong type: guide and exhaust. Xie Xin/Shi Zao type: drain due to fullness. Exterior: sweat. Interior: purge. Half-exterior/half-interior: harmonize. More exterior/less interior: harmonize with slight sweating. More interior/less exterior: harmonize with slight purging. Upper: emesis. Middle Qi deficiency/micro pulse: warm. All depend on flexible application. If exterior/interior/sweat/purge methods are inappropriate, life/death hangs in the balance. Must think deeply and distinguish clearly.
According to Tao Hua's *Shanghan Qi Meng*: Fever, aversion to cold, head/neck pain, lumbar/spine rigidity: Taiyang channel. Body heat, eye pain, nasal dryness, insomnia: Yangming channel. Chest/hypochondriac pain, deafness, bitter taste, dry tongue, alternating chills/fever, vomiting: Shaoyang channel. Abdominal fullness, throat dryness, warm hands/feet, or spontaneous diarrhea, no thirst, or intermittent abdominal pain: Taiyin channel. Pulling clothes, curling up, aversion to cold, or dry tongue/mouth: Shaoyin channel. Irritability, fullness, scrotal contraction: Jueyin channel. Tidal fever, spontaneous sweat, delirium, thirst, no aversion to cold, aversion to heat, removing blankets, throwing hands/legs, macules/jaundice, madness, no bowel movement for 5-6 days: Zheng Yang Ming Stomach Fu. If pulse/symptoms unclear, misusing Ma Huang causes excessive sweating and Yang collapse. Misusing Cheng Qi causes incontinence. Misusing Jiang/Fu causes bleeding and madness. Cold drugs drain Stomach Qi; acrid-hot drugs damage Sweat Fluids; dry-heat aids Pathogenic Heat. Vulgar hesitation is worst. Shanghan pathogen has no fixed form. Entering Yang Qi level starts with Taiyang, pulse floating. Entering Yin Blood level starts with Shaoyin, pulse deep. Floating force/forceless determines Exterior deficiency/excess. Deep force/forceless determines Interior deficiency/excess. Middle force/forceless determines Exterior/Interior urgency. Pulses have floating/deep/deficiency/excess; symptoms change constantly. Depends on "Flexible Method," not fixed days. See Taiyang syndrome: attack Taiyang directly. See Shaoyin syndrome: attack Shaoyin directly. See True Cold: rescue True Cold directly. These three syndromes allow decision-making without needing all symptoms. Know how to treat; this is Flexible Method. Clarify same-but-different; distinguish seemingly-similar-but-different. Exterior: sweat, disperse. Interior: purge, drain. Upper: induce emesis. Sunken: lift and raise. Middle: harmonize. Directly entering Yin channels: warm and tonify. If not resolved, do not purge Interior. Days may be many, but if exterior syndrome exists and pulse is floating, still disperse. Ignorance here makes purging adverse. Scripture: One mistake delays death; two hasten it. If exterior resolves and interior presents, do not attack exterior. Days may be few, but if interior heat syndrome exists and pulse is wiry-solid, urgently purge. Ignorance here brings disaster instantly. Scripture: Unremoved heat plus dry heat is like adding wood to fire. Directly entering Yin True Cold: no heat, aversion to cold, no thirst. Only warm/tonify; strictly forbid cold drugs. Ignorance kills quickly. Scripture: Not useless, but harmful. Yin syndrome resembling Yang: warm. Yang syndrome resembling Yin: purge. Yang Toxin: purge by severity. Yin Toxin: warm by urgency. Yang Mania: purge. Yin Collapse: warm. Damp-Heat Jaundice: drain, purge. Blood Stasis Jaundice: resolve, purge. Delirium: purge, warm. Fullness: dissipate, drain. Chest Binding: resolve, purge. Taiyang with Shaoyin: warm. Shaoyin resembling Taiyang: sweat. Nosebleed: resolve, stop. Wheezing: sweat, purge. Cough: drain, resolve. True Shanghan: heavy sweat, heavy purge. Contracted/Caught Cold: slight sweat, slight purge. Labor-induced Cold: warm-disperse. Extreme Heat: slight resolve, heavy purge. These are standard methods. Using hot then cold drugs (e.g., Shaoyin using Bai Hu/Si Ni San) or cold then hot (e.g., Shaoyin using Si Ni/Zhen Wu) confuses vulgar doctors. Alas! Knowing Shanghan syndrome names and formula/pulse correlations constitutes a good physician. Cold drugs for Shaoyin: transmitted heat syndrome. Hot drugs for Shaoyin: direct invasion Yin channel, True Cold syndrome. Distinguish names, fix channels, clarify pulses, recognize symptoms, verify symptoms for medication. Know Exterior requires sweating, Interior requires purging, Direct Yin invasion requires warming. Sweat thus, purge thus, warm thus. Acrid-hot fails? Cold drugs succeed? How can disease escape? Distinguish severity, urgency, age, constitution, chronic/new, female pregnancy/menses, maiden menstruation. Pregnancy/labor Shanghan differs from male treatment; non-pregnant same. Menstruation just started/stopped: Heat entering Blood Chamber, harmonize exterior/interior. Chronic: passed channel, unresolved, damaged syndrome. New: initial illness. Elderly: Qi/Blood decline. Young: Qi/Blood robust. Slow: mild disease. Urgent: severe disease. Cold drugs taken hot, hot drugs...