治伤寒恶候
舶上硫黄 附子（去皮生用） 新腊茶（各一两）
上为细末。先将好酒一斤。调药。分大新碗五口中。放于火上。摊荡令干。合于瓦上。每一碗下。烧熟艾一拳大。
以瓦 起。无令火着。直至烟尽。冷即刮取。却细研。入瓷合成。每服二钱。酒一盏。煎至七分。有火焰起。勿讶。取
起待温。服下丸药。伤寒阴毒者。四肢冷。脉沉细。或吐或泻。五心躁烦。胸中结硬。或转作伏阳在内。汤水不得下。
或无脉。先吃一服。如吐。却更进一服。服后。心中热。其病已瘥。下至脏腑中。表未解者。浑身壮热。脉气洪大。便
宜用发表药。或表解者。更不发热。便得眠睡。浑身有汗。若少有痞结。脉实方可用下胸膈。行脏腑药。渐用调和脾胃。
补养元气汤散。如服此药二服。不应。不可治也。
琥按上云治伤寒恶候者。乃阴寒已甚。恶极之候也。方用硫黄黑附以回阴盛。腊茶以调隔阳也。方后云。表未解者。
宜用发表药。此即仲景云先温其里。乃攻其表也。又云若少有痞结脉实方可用行下药。盖寒实之证。先消导而后调补也。
见活人书第十六卷中兹不更录
琥按丹砂丸。与上来复丹。及后元戎调胃散相类。乃有毒镇坠之药。不可服也。
夫伤寒病之说。始自皇帝以开其端。至仲景陈其条目。自后肤浅之学。莫知其数。立言者云。病在表。可发汗。病
在里。可下之。或云。不可汗。不可下。即未尝有温中之说。仲景伤寒论例云。尺寸俱沉细。太阴受病也。尺寸俱沉。
少阴受病也。尺寸俱微缓。厥阴受病也。又辩太阴证云。太阴病脉浮。可发汗。宜桂枝汤。又手足温。自利不渴。宜四
逆汤。又腹满时痛。桂枝芍药汤。辩少阴证云。少阴病始得之。发热脉沉。麻黄附子细辛汤。又少阴病二三日。麻黄附
子甘草汤。又少阴病脉沉。急温之。宜四逆汤。又少阴病身体疼痛。手足寒。骨节痛。脉沉。附子汤。辩厥阴证云。厥
阴病吐利。手足厥。逆冷。烦躁欲死。吴茱萸汤。今举仲景论中数条。最是治三阴之良法。于今世用之。尚有未尽证者。
愚尝校量。自至和初岁迄于今三十余年。不以岁之太过不及为则。每夏至以前。有病伤寒人。十中七八。两手脉俱沉细
数。多是胸膈满闷。或呕逆。或气塞。或肠鸣。或腹痛。与仲景三阴病之说。脉理同而证不同。因兹不敢妄投仲景治三
阴病药。医者才见脉沉。及胸膈满。便投下药下之。往往不救。尝斟酌仲景理中丸。与服之。其病势轻者。即胸中便快。
病势重者。半日许。满闷依然。或有病患脉沉细迟。投仲景四逆汤温之。多药力大热。后必发烦躁。因校量此形证。今
别立方以治之。多得中病。不可不传焉。
病患但两手脉沉细数。或有力。或无力。或关脉短。及力小。胸膈塞闷。气短不能相接者。便可随脉证。投温中药
以治之。病患两手脉沉迟。或紧或缓。皆为胸中寒也。若寸脉短。及力小于关尺者。此是阴盛阳虚也。或胸膈满闷。腹
中胀痛。身体拘急。手足逆冷。宜急温之。
若立春以后。至清明以前。宜温中汤主之。清明以后。芒种以前。宜橘皮汤主之。芒种以后。至立秋以前。宜七物
理中丸主之。
治疗伤寒的危重证候。
使用舶上硫黄、附子（去皮，生用）、新腊茶（各一两）。
将上述药物研成细末。先取好酒一斤，调和药末，分装在五个崭新的碗中。放在火上，不断晃动直到药液煎干。盖上瓦片，每碗下面放置一大拳大小的熟艾绒。
用瓦片盖住，不要让火直接烧着药，直到烟雾燃尽。冷却后刮取药粉，再次细细研磨，装入瓷罐中密封保存。每次服用二钱，用一盏酒，煎至七分满。如果有火焰升起，不要惊讶。取起待温后，服用丸药。
如果是伤寒阴毒证，表现为四肢冰冷，脉象沉细，或者呕吐或腹泻，五心烦热躁动，胸中痞结坚硬，或者转变为伏阳在内，汤水无法下咽。
或者无脉象。先服用一剂。如果发生呕吐，再进服一剂。服药后，心中感到温热，病情就会痊愈。
如果病邪深入脏腑，但表证未解，会出现全身高热，脉象洪大，适宜使用发表药。
如果表证已解，不再发热，就能入睡，全身出汗。如果稍有痞结，且脉象实，才可以使用泻下胸膈、通利脏腑的药物。逐渐使用调和脾胃、补养元气的汤散。
如果服用此药两剂无效，就无法治愈了。
丹波琥按：上面所说的治疗伤寒危重证候，是指阴寒极盛，恶寒至极的证候。方中使用硫黄和黑附子以回阳救逆，抑制阴寒过盛；使用腊茶以调理格拒之阳（即真寒假热导致的阳气格拒）。方后注说：表证未解者，适宜使用发表药。这正如张仲景所说：先温其里，然后攻其表。又说：如果稍有痞结且脉象实，才可以使用行下药。这是因为寒实证的治法，是先消导积滞，然后进行调补。
见《活人书》第十六卷中，此处不再重复收录。
丹波琥按：丹砂丸，与上面的来复丹，以及后来的《元戎》调胃散相似，都是有毒且具有镇坠作用的药物，不可服用。
关于伤寒病的学说，始于黄帝开启其端绪，到张仲景阐述其条目。自那以后，肤浅的学问多得数不清。立论的人说：病在表，可以发汗；病在里，可以泻下。或者说：不可以发汗，不可以泻下。却从未有过“温中”的说法。
张仲景《伤寒论例》中说：尺寸脉俱沉细，是太阴经受病；尺寸脉俱沉，是少阴经受病；尺寸脉俱微缓，是厥阴经受病。
又辨析太阴证说：太阴病脉浮，可发汗，宜用桂枝汤。又手足温暖，自发性腹泻且不口渴，宜用四逆汤。又腹部胀满伴有时痛，用桂枝芍药汤。
辨析少阴证说：少阴病初得之时，发热脉沉，用麻黄附子细辛汤。又少阴病二三日，用麻黄附子甘草汤。又少阴病脉沉，急当温之，宜用四逆汤。又少阴病身体疼痛，手足寒冷，骨节痛，脉沉，用附子汤。
辨析厥阴证说：厥阴病呕吐腹泻，手足厥冷，烦躁欲死，用吴茱萸汤。
现在列举张仲景论著中的这几条，是最为治疗三阴病的良法。但在当今世道使用这些方法，仍有未尽之处。
我曾经统计，自从至和初年到现在三十多年，不以岁运的太过或不及为标准，每逢夏至以前，患伤寒病的人，十中有七八人，两手脉象都沉细数。多是胸膈满闷，或者呕吐逆气，或者气机阻塞，或者肠鸣，或者腹痛。这与张仲景三阴病的说法，脉理相同而症状不同。因此不敢妄投张仲景治疗三阴病的药物。
医生们只要见到脉沉，及胸膈满闷，就投用泻下药攻下，往往导致病人死亡。
我曾经斟酌使用张仲景的理中丸给病人服用，病情轻的，胸中便觉爽快；病情重的，半天左右，满闷依旧。
有的病患脉象沉细迟，投用张仲景的四逆汤温之，多因药力大热，之后必然引发烦躁。
因为校量这种形证，现在另外制定方子来治疗，大多能中病。不可不流传下去。
病患只要两手脉象沉细数，或者有力，或者无力，或者关脉短，及力量小，胸膈塞闷，气短不能相接的，便可随脉证，投用温中药来治疗。
病患两手脉象沉迟，或者紧或者缓，都是胸中有寒。如果寸脉短，及力量小于关尺脉的，这是阴盛阳虚。或者胸膈满闷，腹中胀痛，身体拘急，手足逆冷，宜急温之。
如果在立春以后，至清明以前，宜用温中汤主治。清明以后，芒种以前，宜用橘皮汤主治。芒种以后，至立秋以前，宜用七物理中丸主治。
Treatment of severe conditions in Shanghan (Cold Damage).
Bo-shang Liu Huang (Sulfur imported from overseas), Fuzi (Aconiti Lateralis Radix Preparata, peeled and used raw), Xin La Cha (New Year's Tea) (each 1 liang).
Grind the above into a fine powder. First, take 1 jin of good wine, mix with the medicine powder, divide into five new bowls. Place on fire, shake until dry. Cover with tiles, place a fist-sized amount of cooked Ai Ye (Artemisiae Argyi Folium / Moxa) under each bowl.
Cover with tiles, do not let fire touch directly, until smoke is exhausted. Scrape off when cold, grind finely again, store in porcelain. Each dose: 2 qian. Take with 1 zhan of wine, decoct to 70%. If flames rise, do not be surprised. Take up, wait for warmth, then take the pill medicine.
For Yin Du (Yin Toxin) syndrome in Shanghan: cold limbs, deep and fine pulse, or vomiting or diarrhea, five-center heat and irritability, chest oppression and hardness, or transformation into latent Yang inside, inability to swallow soup/water.
Or absence of pulse. Take one dose first. If vomiting occurs, take another dose. After taking, if the heart feels warm, the disease will heal.
If pathogens have entered the Zang-Fu but the exterior is not resolved: whole-body high fever, surging and large pulse. Suitable to use exterior-releasing medicines.
If exterior is resolved, no more fever, able to sleep, whole-body sweating. If slight stagnation remains, and pulse is excess/solid, only then can purgatives for chest/diaphragm and bowel-regulating medicines be used. Gradually use spleen/stomach-harmonizing and Qi-Yuan-nourishing decoctions/powders.
If two doses of this medicine are ineffective, it cannot be treated.
Danbo Hu notes: The aforementioned treatment of severe Shanghan conditions refers to extreme Yin-Cold and extreme aversion-to-cold conditions. The formula uses Liu Huang (Sulfur) and Hei Fu Zi (Black Aconite) to restore Yang and overcome excessive Yin; La Cha (Tea) to regulate separated Yang (Yang repulsion). The post-formula note says: For those with unresolved exterior, suitable to use exterior-releasing medicines. This aligns with Zhang Zhongjing's saying: "First warm the interior, then attack the exterior." It also says: "If slight stagnation exists and pulse is solid, purgatives may be used." This is because for Cold-Excess syndromes, the method is first to resolve accumulation, then tonify.
Seen in Volume 16 of *Huoren Shu*, not repeated here.
Danbo Hu notes: Dansha Wan (Cinnabar Pill) is similar to the aforementioned Laifu Dan and the later *Yuanrong* Tiaowei San. These are toxic drugs with sedative/heavy properties and should not be taken.
The theory of Shanghan disease began with the Yellow Emperor opening its beginnings, and Zhang Zhongjing elaborating its categories. Since then, superficial studies have been countless. Proponents say: Disease in the exterior can be treated by sweating; disease in the interior can be treated by purging. Or say: Cannot sweat, cannot purge. Yet there has never been a theory of "Warming the Middle."
Zhang Zhongjing's *Shanghan Lun Li* states: Cun and Chi pulses both deep and fine indicate Taiyin involvement. Cun and Chi pulses both deep indicate Shaoyin involvement. Cun and Chi pulses both weak and slow indicate Jueyin involvement.
Regarding Taiyin syndrome: Taiyin disease with floating pulse can be sweated, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. With warm hands/feet, spontaneous diarrhea without thirst, Sini Tang (Frigid Extremities Decoction) is appropriate. With abdominal fullness and occasional pain, Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction) is appropriate.
Regarding Shaoyin syndrome: Early Shaoyin disease with fever and deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) is appropriate. Shaoyin disease after 2-3 days, Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) is appropriate. Shaoyin disease with deep pulse requires urgent warming, Sini Tang is appropriate. Shaoyin disease with body pain, cold hands/feet, joint pain, and deep pulse, Fuzi Tang (Aconite Decoction) is appropriate.
Regarding Jueyin syndrome: Jueyin disease with vomiting, diarrhea, cold extremities, and irritability bordering on death, Wuzhuyu Tang (Evodia Decoction) is appropriate.
I cite these few lines from Zhang Zhongjing as excellent methods for treating the Three Yin diseases. However, using them in modern times still leaves some cases unaddressed.
I have calculated that from the beginning of Zhihe era to now, over thirty years, regardless of annual climatic excess or deficiency, before Summer Solstice, 70-80% of Shanghan patients have deep, fine, and rapid pulses in both hands. Symptoms often include chest/diaphragm fullness, vomiting/reversal of Qi, Qi obstruction, borborygmus, or abdominal pain. The pulse logic matches Zhang Zhongjing's Three Yin diseases, but symptoms differ. Thus, I dare not recklessly prescribe Zhang Zhongjing's Three Yin treatments.
Physicians seeing deep pulse and chest fullness immediately use purgatives, often resulting in death.
I once tried Zhang Zhongjing's Lizhong Wan (Regulate the Middle Pill). Mild cases felt relief in the chest; severe cases remained full after half a day.
Some patients with deep, fine, slow pulses were given Sini Tang to warm them, but due to excessive heat potency, they subsequently developed irritability.
Based on analyzing these signs and symptoms, I have formulated new prescriptions which mostly hit the mark. This must be transmitted.
If patients have deep, fine, rapid pulses in both hands (excess or deficient), or short Guan pulse with weak force, accompanied by chest/diaphragm blockage and shortness of breath, treat with Middle-Warming medicines according to pulse and symptoms.
If patients have deep, slow, tight, or relaxed pulses in both hands, it indicates Cold in the Chest. If Cun pulse is short and weaker than Guan/Chi, it indicates Yin Excess and Yang Deficiency. Symptoms may include chest/diaphragm fullness, abdominal distension/pain, body stiffness, and cold extremities; urgent warming is required.
From after Start of Spring to before Clear Brightness, Wenzhong Tang (Warm Middle Decoction) is primary. From after Clear Brightness to before Grain in Ear, Chupi Tang (Tangerine Peel Decoction) is primary. From after Grain in Ear to before Start of Autumn, Qi Wu Lizhong Wan (Seven-Ingredient Regulate-Middle Pill) is primary.