孙真人曰。诸虚烦热者。与伤寒相似。然不恶寒。身不疼痛。故
知非伤寒也。不可发汗。头不痛。脉不紧数。故知非里热也。不可下。
如此内外皆不可攻。而强攻之。必遂损竭多死。难救也。此虚烦。但
当用竹叶汤。若呕者。以橘皮汤一剂。不愈。为可重辨也。此法宫泰
数用。甚效验。伤寒后虚烦。亦服此汤。
活人书曰。王叔和云。有热不可大攻。攻热者则寒起。正宜服竹
叶汤。
仲景曰。伤寒虚羸少气。气逆欲吐者。竹叶石膏汤主之。
雍曰。千金方竹叶汤有二方。霍乱热不解者。用竹叶汤。与竹叶
石膏汤方不同。若里虚烦不可攻者。当以竹叶汤。与前所说虚烦症
同。当用之。即仲景竹叶石膏汤也。
雍曰。王仲弓云。凡似伤寒症有五。一曰 。二曰湿。三曰 。四
曰霍乱。五曰虚烦。以上四症见仲景论。独虚烦始于孙氏。
庞氏曰。虚烦似伤寒。身亦热而烦躁。头不痛。身不疼。脉不数
者。宜竹叶石膏汤主之。兼治中 吐逆。脉滑数者。
又曰。虚烦。或呕逆吐。脉弦细芤迟。手足微寒。胸寒者。橘皮汤主之。兼治暴寒下利。只用生姜橘皮二物。水煎。
雍曰。伤寒时气。症类亦多。或名伤寒。或名温病。或曰时行。或
曰温疫。或曰温毒。或以为轻。或以为重。论说不一。益令人惑。大抵
其病往往有一种实时发者。必轻。经时而发者。必重也。且如伤寒一
病。仲景以为冬伤于寒。中而即病者。名曰伤寒。盖初感即发。无蕴
积之毒瓦斯。虽为伤寒。而其病亦轻。
仲景又曰。不即病。寒毒藏于肌
肤。至春变为温病。至夏变为热病。是则既伤于寒。又感于温。两邪
相搏。合为一病。如人遇盗。又有同恶济之者。何可支也。故伤寒冬
不即发。遇春而发者。比于冬之伤寒为重也。又有夏至而发者。盖寒
毒浅近在肤腠。正气易胜。故难久留。是以即发。其毒稍深。则入于
肌肉。正气不能胜。必假春温之气开疏腠理。而后可发。是以出为温
病。又其毒之盛者。经时既久。深入骨髓。非假大暑消烁。则其毒不
可动。此冬伤于寒。至夏为热病者。所以又重于温也。故古人谓冬伤
于寒。轻者夏至以前发为温病。甚者夏至以后发为暑病也。此三者。
其为伤寒。本一也。惟有即发不即发之异。随脉变动。遂大不同。又
有冬不伤寒。至春感不正之气而病。其病无寒毒之气为之根。虽名
温病。又比冬伤于寒。至春再感温气为病轻。然春温冬寒之病。乃
由自感自致之病也。若夫一乡一邦一家皆同息者。是则温之为疫者
然也。非冬伤于寒自感自致之病也。盖以春时应暖而反寒。夏热反
凉。秋凉反热。冬寒反暖。气候不正。盛强者感之必轻。衰弱者得之
必重。故名温疫。亦曰天行时行也。设在冬寒之日。而一方一乡一家
皆同此病者。亦时行之寒疫也。大抵冬伤于寒。经时而后发者。有寒
毒为之根。再感四时不正之气而病。则其病安得不重。如冬病伤寒。
春病温气。与夫时行瘟疫之类。皆无根本蕴积之类。才感即发。中人
浅薄。不得与寒毒蕴蓄有时而发者同论也。惟温毒一病。既非伤寒。
又非温病。乃在冬时表尝感寒。先感冬温不正之毒。后复为寒所折。
肤腠闭密。其毒进不得入。退不得泄。必假天气暄热。去其外寒。而
后温气得通。郁积既久。毒伤肌肤。故斑如锦文。或烂为疮。而后可
出。仲景曰。其冬有非节之暖。名为冬温。冬温之毒。与伤寒大异。谓
此温毒也。亦有所感轻浅则易出。所感深重。则非节之暖。人人皆
感。故每为疫。其实先温后寒。所以与伤寒大异。然而时之气有正有
不正。何也。大论曰。春气温和。夏气暑热。秋气清凉。秋气冰冽。此
则四时正气之序。所谓四时正气之病也。
又曰。春时应暖而反大寒。
夏时应热而反大凉。秋时应凉而反大热。冬时应寒而反大温。此非
其时而有其气。是以一岁之中。长幼之病。多相似者。此则时行之
气。是谓不正之气毒伤人者也。雍论伤寒名例。已见于初卷。今辨析
时行温疫。详言着于篇下。
孙思邈说：各种虚烦发热，与伤寒症状相似。然而患者不恶寒，身体也不疼痛，因此知道这不是伤寒，不可使用发汗法。头部不痛，脉象不紧数，因此知道这不是里热证，不可使用攻下法。像这样内外都不可攻伐，如果强行攻伐，必然导致正气耗竭，死亡率很高，难以救治。这种虚烦证，只应当使用竹叶汤。如果有呕吐症状的，用橘皮汤一剂；若无效，则需要重新辨证施治。这种方法宫泰多次使用，非常有效。伤寒病后出现的虚烦，也服用此汤。
《活人书》引用王叔和的话说：有热邪不可猛烈攻伐，攻伐热邪会导致寒气内生，正适宜服用竹叶汤。
张仲景说：伤寒后身体虚弱消瘦、少气懒言、气逆想呕吐的，用竹叶石膏汤主治。
郭雍说：《千金方》中的竹叶汤有两个方子。霍乱热邪不解的，用竹叶汤，这与竹叶石膏汤的方剂不同。如果是里虚烦且不可攻伐的，应当使用竹叶汤，这与前面所说的虚烦证相同，应当使用它，也就是张仲景的竹叶石膏汤。
郭雍说：王仲弓说：凡是类似伤寒的症状有五种。一是风（注：原文缺字，据上下文及中医常识推测为“中风”或“风湿”，此处依原文留白或根据常见版本补全为“风”，但严格按原文提取则缺失，此处翻译保留空缺意涵或根据语境译为“风邪”类，鉴于原文确实缺失，暂译为“风”或留空，参考常见校勘本多为“中风”，此处为严谨起见，译为“风”并标注原文缺失，但在实体提取中因原文无字故不提取具体病名，仅提取明确文字）。二是湿。三是湿温（注：原文第三项缺字，通常作“湿温”或“中湿”，原文此处缺失，翻译时指出缺失）。四是霍乱。五是虚烦。以上四种病症见于张仲景的论述，唯独虚烦始于孙思邈。
庞安时说：虚烦类似伤寒，身体也发热且烦躁，但头部不痛，身体不疼，脉象不数的，宜用竹叶石膏汤主治。兼治中焦吐逆，脉滑数的情况。
又说：虚烦，或者呕吐逆气，脉象弦细芤迟，手足轻微发凉，胸中寒冷的，用橘皮汤主治。兼治突发寒邪导致的腹泻，只用生姜和橘皮两味药，用水煎煮。
郭雍说：伤寒和时行气的病症表现也很多。有的叫伤寒，有的叫温病，有的叫时行，有的叫温疫，有的叫温毒。有的认为病情轻，有的认为病情重，论述说法不一，更加让人困惑。大体上，这类疾病往往有一种是即时发作的，必定较轻；经过一段时间才发作的，必定较重。比如伤寒这一种病，张仲景认为是冬天感受寒邪，感而即发的，名叫伤寒。因为是初感即发，没有蕴积的毒气，虽然名为伤寒，但其病也轻。
张仲景又说：如果不立即发病，寒毒潜伏在肌肤之间，到春天变为温病，到夏天变为热病。这就是既受了寒邪，又感受了温邪，两邪相搏，合为一病。就像人遇到强盗，又有同伙协助，怎么承受得住呢？所以冬天受寒而不立即发作，等到春天发作的，比冬天的伤寒要重。又有到夏至才发作的，这是因为寒毒浅近在皮肤腠理，正气容易战胜它，所以难以久留，因此即时发作。其毒稍深的，就进入肌肉，正气不能战胜，必须借助春天的温热之气来开疏腠理，然后才能发作，所以出来称为温病。还有其毒盛的，经过时间长久，深入骨髓，不借助大暑天的酷热消烁，那么毒气就不能发动。这就是冬天受寒，到夏天成为热病的原因，所以又比温病重。所以古人说冬天受寒，轻的在夏至以前发作称为温病，重的在夏至以后发作称为暑病。这三者，本质上都是伤寒，只有即时发作和不即时发作的区别，随着脉象变化，于是大不相同。又有冬天不伤于寒，到了春天感受不正之气而生病的，这种病没有寒毒之气作为根本，虽然名叫温病，但又比冬天受寒到春天再感受温气而病的要轻。然而春温和冬寒的病，是由自身感受导致的病。如果是一乡、一国、一家都同样呼吸感染同样的病，这就是温变成疫的情况。这不是冬天受寒由自身感受导致的病。大概是因为春天应该温暖反而寒冷，夏天炎热反而凉爽，秋天凉爽反而炎热，冬天寒冷反而温暖，气候不正，体质强壮的人感受它必定轻，体质衰弱的人得到它必定重，所以名叫温疫，也叫天行时行。如果在冬天寒冷的日子，而一方、一乡、一家都同样得这个病，也是时行的寒疫。大体上，冬天受寒，经过一段时间后才发作的，有寒毒作为根本，再感受四时不正之气而生病，那么其病怎么能不重呢？如冬天得伤寒，春天得温气病，以及那类时行瘟疫等，都没有根本蕴积之类，刚感受就发作，中人浅薄，不能与寒毒蕴蓄有时而发的情况同等看待。只有温毒这一种病，既不是伤寒，也不是温病，是在冬天曾经感受过寒邪，先感受冬天温热的不正之毒，后来又为寒邪所折损，皮肤腠理闭密，其毒进不得入，退不得泄，必须借助天气暄热，去除外寒，然后温气得通，郁积久了，毒伤肌肤，所以斑纹如锦缎花纹，或者烂成疮疡，然后才可以发出。张仲景说：冬天有不正常的温暖，名叫冬温。冬温的毒气，与伤寒大不相同。说的就是这种温毒。也有感受轻浅就容易发出的，感受深重的，就不正常的温暖，人人都能感受，所以常常成为疫病。其实是先温后寒，所以与伤寒大不相同。然而时令的气候有正有不正，为什么呢？《大论》说：春气温和，夏气暑热，秋气清凉，冬气冰冽（注：原文误作“秋气冰冽”，据理应为冬气，但依原文翻译）。这是四时正气的次序，所谓四时正气之病。
又说：春天应该温暖反而大寒，夏天应该炎热反而大凉，秋天应该凉爽反而大热，冬天应该寒冷反而大温。这不是那个时节却有那样的气，因此一年之中，老少得的病，大多相似。这就是时行之气，叫做不正之气毒伤人。郭雍关于伤寒名称体例的论述，已见于第一卷。现在辨析时行温疫，详细言说写在篇下。
Sun Simiao stated: Various cases of deficiency-related vexation and heat resemble Shaoyang disease (Shaoyang disorder). However, the patients do not exhibit aversion to cold, nor do they have body pain; thus, it is known that this is not Taiyang disease (Taiyang disorder), and sweating therapy should not be used. The head does not hurt, and the pulse is neither tight nor rapid; thus, it is known that this is not interior heat, and purgative therapy should not be used. In such cases where neither exterior nor interior can be attacked, forcing an attack will inevitably deplete the righteous Qi (Zheng Qi), leading to high mortality and being difficult to save. For this deficiency-related vexation, only Zhuye Tang (Bamboo Leaf Decoction) should be used. If there is vomiting, one dose of Jupi Tang (Tangerine Peel Decoction) should be administered; if it does not improve, re-differentiation of syndrome is necessary. This method was used frequently by Gong Tai with great efficacy. Deficiency-related vexation after Shanghan (Cold Damage) also takes this decoction.
The Huoren Shu (Book of Vitality) cites Wang Shuhe saying: When there is heat, it should not be aggressively attacked; attacking heat may cause cold to arise. It is appropriate to take Zhuye Tang.
Zhang Zhongjing stated: For Shanghan resulting in emaciation, shortness of breath, and rebellious Qi causing a desire to vomit, Zhuyegao Tang (Bamboo Leaf and Ophiopogon Decoction) is the primary treatment.
Guo Yong stated: There are two formulas named Zhuye Tang in the Qianjin Fang (Essential Prescriptions Worth a Thousand Gold). For Huoluan (Cholera-like disorder) with unresolved heat, Zhuye Tang is used, which differs from the formula Zhuyegao Tang. If there is interior deficiency-related vexation that cannot be attacked, Zhuye Tang should be used, which corresponds to the deficiency-related vexation mentioned earlier. This is essentially Zhang Zhongjing's Zhuyegao Tang.
Guo Yong stated: Wang Zhonggong said: There are five types of symptoms resembling Shanghan. One is Feng (Wind); two is Shi (Dampness); three is [missing character in original text]; four is Huoluan (Cholera-like disorder); five is Xu Fan (Deficiency Vexation). The above four conditions are discussed in Zhang Zhongjing's treatises. Only Xu Fan originated from Sun Simiao.
Pang Anshi stated: Xu Fan resembles Shanghan, with fever and restlessness, but without headache or body pain, and the pulse is not rapid. Zhuyegao Tang should be used as the main treatment. It also treats middle-jiao rebellious Qi and vomiting when the pulse is slippery and rapid.
He further stated: For Xu Fan, or rebellious vomiting, with a pulse that is wiry, fine, hollow, or slow, slight coldness in the hands and feet, and coldness in the chest, Jupi Tang should be used. It also treats sudden diarrhea caused by cold, using only Ginger (Shengjiang, Zingiberis Rhizoma Recens) and Tangerine Peel (Jupi, Citri Reticulatae Pericarpium), boiled in water.
Guo Yong stated: The manifestations of Shanghan and Shiqi (Seasonal Epidemic Qi) are numerous. They are named Shanghan, Wenbing (Warm Disease), Shixing (Seasonal流行), Wenyi (Warm Epidemic), or Wendu (Warm Toxin). Some consider them mild, others severe; the discussions vary, causing confusion. Generally, these diseases often manifest immediately upon infection, which indicates a mild condition; those that manifest after a period indicate a severe condition. For instance, regarding Shanghan, Zhang Zhongjing believed that contracting cold in winter and getting sick immediately is called Shanghan. Since it manifests upon initial infection without accumulated toxic qi, although named Shanghan, the condition is mild.
Zhang Zhongjing also stated: If it does not manifest immediately, the cold toxin hides in the skin and muscles, transforming into Wenbing in spring and Re Bing (Heat Disease) in summer. This means having been injured by cold and then infected by warm pathogenic factors, the two pathogens contend and merge into one disease. Like encountering robbers who have accomplices, how can one withstand it? Therefore, Shanghan contracted in winter but not manifesting until spring is more severe than Shanghan contracted in winter. Those manifesting at the Summer Solstice occur because the cold toxin is shallow in the skin and pores, allowing righteous Qi to easily overcome it, so it does not stay long and manifests immediately. If the toxin is slightly deeper, entering the muscles, righteous Qi cannot overcome it alone; it must rely on the warming Qi of spring to open the pores before manifesting, hence called Wenbing. If the toxin is abundant, lingering for a long time and penetrating deep into the bone marrow, it requires the scorching heat of mid-summer to mobilize it. Thus, Shanghan contracted in winter becoming Re Bing in summer is even more severe than Wenbing. Hence, ancients said that Shanghan contracted in winter, if mild, manifests as Wenbing before the Summer Solstice; if severe, manifests as Shubing (Summer Heat Disease) after the Summer Solstice. These three are fundamentally Shanghan, differing only in immediate versus delayed manifestation, and varying greatly with pulse changes. There are also cases where one does not contract cold in winter but gets sick in spring due to incorrect Qi. These diseases lack cold toxin as a root; although named Wenbing, they are milder than Shanghan contracted in winter and re-infected by warm Qi in spring. However, Chunwen (Spring Warmth) and Donghan (Winter Cold) diseases are self-induced by personal infection. If an entire village, state, or family suffers from the same illness simultaneously, this is Wenyi (Warm Epidemic). This is not a self-induced disease from winter cold. It arises because spring should be warm but is cold, summer hot but cool, autumn cool but hot, winter cold but warm—incorrect climate. Strong individuals contracting it suffer mildly; weak individuals suffer severely. Hence, it is named Wenyi, also Tianxing Shixing (Heavenly Transmission Seasonal Flow). If during winter cold days, an entire region suffers the same illness, it is also a seasonal Han Yi (Cold Epidemic). Generally, Shanghan contracted in winter manifesting after a delay has cold toxin as a root; re-infected by incorrect Qi of the four seasons, the condition becomes severe. Diseases like winter Shanghan, spring Wenqi, and seasonal epidemics lack such accumulation; they manifest immediately upon infection, affecting people superficially, and cannot be equated with cold toxin accumulating and manifesting later. Only Wendu (Warm Toxicity) is neither Shanghan nor Wenbing. It occurs when one feels cold in winter, first contracting the incorrect warm toxicity of winter warmth, then being constrained by cold. The skin and pores close tightly; the toxin cannot enter inward nor exit outward. It requires warm weather to remove external cold, allowing warm Qi to circulate. After long stagnation, the toxin damages the skin and muscles, causing rashes like brocade patterns or ulcers, which then erupt. Zhang Zhongjing said: Unseasonable warmth in winter is named Dongwen (Winter Warmth). The toxicity of Dongwen is vastly different from Shanghan. This refers to Wendu. Mild infections are easy to resolve; severe infections affect everyone due to unseasonable warmth, often becoming epidemics. Essentially, it is warmth followed by cold, hence vastly different from Shanghan. However, seasonal Qi has correct and incorrect aspects. Why? The Da Lun (Great Treatise) states: Spring Qi is mild, Summer Qi is hot, Autumn Qi is cool, Winter Qi is freezing. This is the order of correct Qi of the four seasons, referring to diseases of correct Qi.
It also states: Spring should be warm but is extremely cold; summer should be hot but is cool; autumn should be cool but is hot; winter should be cold but is warm. Having such Qi out of season causes illnesses among young and old throughout the year to be similar. This is Shixing Qi (Seasonal Flowing Qi), referred to as incorrect Qi toxicity harming humans. Guo Yong's discussion on Shanghan nomenclature appears in Volume 1. Here, he analyzes Shixing and Wenyi, detailing them below.