战汗者。邪正相争也。经云。脉浮而紧。按之反芤。此为本虚。故当战而汗出也。其人
本虚
。故当发战。以脉浮。故当汗出而解。观此则知战乃邪气向外之征。而当欲出未出之界。因
本虚必先发战。而正犹足以拒邪。故战而汗出。为病解之佳兆也。
战邪向外者也。若邪向内者。则不名之曰战。而名之曰栗。战者身战也。栗者心战也。
经云。
阴中于邪。必内栗也。又云。胃无谷气。脾涩不通。口急不能言。其人则战而栗。战与栗有
阴阳之分。不可不知。又有名为振者。与战相近。但战则身为之战摇。振但森然耸动而已。
其人素虚。至欲汗之时。必蒸蒸而振。却发热汗出而解。是振较之战
为轻也。如经所云。亡血家发汗则寒栗而振。与夫下后复发汗其人振寒者。皆虚象也。然此
犹浅焉者也。若经云。若吐若下后。心下逆满。气上冲胸。起则头眩。发汗则动经。身为振
振
摇者。茯苓桂枝白术甘草汤主之。又云太阳病发汗不解。其人仍发热。心下悸。头眩身 动
振振欲擗地者。真武汤主之。此之振也。亟与回阳。犹恐不及。又非战汗所可同日语矣。
战汗之脉。以浮缓为主。浮则邪出于表。缓则胃气自和。可以托邪外出。而又必察其气
。气
细而长者吉。气粗而短者危。战汗之时。不可服药。补则汗不透而留邪为患。泄则正气不支
而成虚脱。只宜多与热汤。养津液以助其作汗。须静候其脉静气长。便属无害。不必惊慌。
俟战止之后。再察其有无留邪。按法施治。若当战时而惊骇叫唤。则神气先乱。邪反胜正。
转为危候。不可治矣。
大凡风寒之邪。自表而里。战汗者少。湿热之邪。自里而表。战汗者多。战汗之后。脉
静身
凉。舌胎已净。胸腹无阻。渐思饮食。斯为全解。否则余邪未净而复热。则有再作战汗而解
者。有战汗至三四次而解者。总视里证以为据。又或战定之后。其人忽沉沉睡去。如死一般
。须
察其脉仍和缓有根者勿讶。俟其气复即醒矣。亦间有脉停者。又必察其呼吸。如呼吸尚长。
此属脉厥。久之自复。亦勿讶也。
战解固为佳兆。又或其人脉促气粗。形体不仁。水浆不下。目直视。舌痿不能言。此则
欲脱之象。而非战解之象矣。
战汗非由发汗而得。若病之可发汗者。邪在于表也。发汗则汗自出。奚俟于战。战汗者
。由
里出表也。故往往有清凉攻下之剂。绝不参一毫表药。自得战汗而解者。此由表里通达。阴
阳交和。自然而然。而非可逼之使汗也。
战汗，是邪气与正气相互抗争的表现。《内经》说：脉象浮而紧，重按却中空（芤脉），这是本元虚弱的表现，所以应当出现战栗而后出汗的症状。患者本身正气虚弱，所以必然会出现战栗；因为脉象浮，说明邪气在表，所以应当通过出汗来解除病邪。从这一点可以看出，“战”是邪气向外透发的征兆，正处于想要排出但尚未排出的临界状态。因为本元虚弱，所以必须先发生战栗，而正气尚足以抵御邪气，因此战栗后出汗，是疾病痊愈的良好预兆。
“战”是邪气向外的表现。如果邪气向内，就不称为“战”，而称为“栗”。所谓“战”，是指身体战栗；所谓“栗”，是指心中恐惧战栗。《内经》说：“阴分受到邪气侵袭，必定内心战栗。”又说：“胃中缺乏谷气，脾运涩滞不通，口唇紧急不能言语，这样的人就会既战栗又恐惧。”战与栗有阴阳的区别，不可不明了。又有称为“振”的，与“战”相近，但“战”是全身战摇，“振”只是皮肤毛发森然耸动而已。这类人平素体虚，到了将要出汗的时候，必然感到体内热气蒸腾并伴有寒战，随后发热出汗而病解。这种“振”比“战”要轻微。如《内经》所说：亡血之人发汗，则会出现寒栗和震颤；以及攻下之后再次发汗，导致患者出现震颤恶寒的情况，这些都是虚损的表现。然而这些还算浅显的。若《伤寒论》中说：经过吐法或下法治疗后，心下逆满，气上冲胸，起身时头晕目眩，此时若再发汗则会扰动经脉，导致身体剧烈震颤摇晃的，用茯苓桂枝白术甘草汤主治。又说：太阳病发汗后病未解，患者仍然发热，心悸，头晕，身体震颤动摇，甚至欲倒地者，用真武汤主治。这里的“振”，急需回阳救逆，还担心来不及，这就不是战汗可以同日而语的了。
战汗的脉象，以浮缓为主。浮表示邪气出于体表，缓表示胃气自然调和，能够托举邪气外出。同时必须观察患者的气息：气息细微而悠长的是吉兆，气息粗重而短促的是危象。在战汗发生时，不可服药。补益药会使汗出不透彻而留邪为患；泻下药会使正气不支而导致虚脱。只宜多给予热汤，滋养津液以助其作汗。必须安静等待其脉象平静、气息悠长，这才属于无害。不必惊慌失措。等到战栗停止之后，再观察是否有残留的邪气，按照法则进行治疗。如果在应当战汗的时候，患者惊恐呼叫，那么神气先乱，邪气反而胜过正气，转变为危重证候，就无法治疗了。
大凡风寒之邪，由表入里，出现战汗的情况较少；湿热之邪，由里出表，出现战汗的情况较多。战汗之后，脉象平静，身体凉爽，舌苔已净，胸腹部没有阻滞感，逐渐想吃东西，这才是完全痊愈。否则，余邪未净而再次发热，则有再次发生战汗而解的，也有战汗三四次才解的，总以里证的表现为依据。或者在战栗定止之后，患者忽然沉沉睡去，像死了一样。必须观察其脉象仍然和缓有根，就不要惊讶，等到元气恢复就会醒来。也间或有脉搏暂时停止的情况，又必须观察其呼吸，如果呼吸还长，这属于“脉厥”，时间久了自然会恢复，也不必惊讶。
战栗后病解固然是好兆头，但如果患者脉象急促、气息粗重，形体麻木不仁，水浆不进，两眼直视，舌体萎缩不能言语，这就是欲脱的征象，而不是战汗病解的征象了。
战汗并非通过发汗疗法得来的。如果是可以通过发汗治疗的病，邪气在表，发汗则汗自然流出，何须等待战栗？战汗，是由里出表的缘故。所以往往有使用清凉攻下的方剂，完全不参入任何解表药物，却自然得到战汗而病解的情况。这是由表里通达，阴阳交和，自然而然形成的，而不是可以逼迫使其出汗的。
Han (shivering) with sweating is the manifestation of the struggle between pathogenic factors and healthy qi. The *Neijing* states: "The pulse is floating and tight, but pressing it feels hollow (Kou pulse); this indicates a deficiency of the root." Therefore, shivering followed by sweating should occur. Since the patient's healthy qi is originally deficient, shivering must ensue. Because the pulse is floating, indicating the pathogen is in the exterior, the disease should resolve through sweating. From this, we know that "han" is a sign of pathogenic factors moving outward, existing at the boundary of being about to emerge but not yet fully out. Due to the root deficiency, shivering must precede sweating, while healthy qi remains sufficient to resist the pathogen. Thus, shivering followed by sweating is a favorable omen for the resolution of the disease.
"Han" refers to the pathogen moving outward. If the pathogen moves inward, it is not called "han," but "li" (trembling/fear). "Han" refers to physical shivering, whereas "li" refers to mental trembling or fear. The *Neijing* states: "When Yin is attacked by pathogens, internal trembling occurs." It also says: "When the Stomach lacks grain qi and the Spleen is sluggish and obstructed, causing tight lips and inability to speak, the person will experience both shivering and trembling." There is a distinction between Han and Li regarding Yin and Yang, which must be understood. There is also a condition called "zhen" (tremor), which is similar to "han." However, in "han," the whole body shakes violently; in "zhen," there is only a sensation of goosebumps and slight trembling. Patients who are constitutionally weak, when approaching the time of sweating, will feel steaming heat accompanied by chills ("zheng zheng er zhen"), followed by fever, sweating, and resolution. This "zhen" is milder than "han." As stated in the classics: "If a blood-deficient patient undergoes sweating therapy, they will experience cold trembling and tremors." Similarly, after purgation followed by re-sweating, if the patient experiences tremors and aversion to cold, these are all signs of deficiency. However, these are relatively superficial cases. Consider the text from the *Shanghan Lun*: "After emesis or purgation, if there is fullness and counterflow in the epigastrium, Qi rushing up to the chest, dizziness upon standing, and subsequent sweating disturbs the meridians causing severe bodily tremors, treat with Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction)." It also states: "In Taiyang disease, if sweating fails to resolve the condition, and the patient still has fever, palpitations, dizziness, and tremors so severe they wish to fall to the ground, treat with Zhen Wu Tang (True Warrior Decoction)." In these cases of "zhen," urgent restoration of Yang Qi is required, lest it be too late; this cannot be discussed on the same level as han sweating.
The pulse associated with han sweating is primarily floating and moderate (Huan). Floating indicates the pathogen exiting the exterior; moderate indicates the harmonization of Stomach Qi, which can support the expulsion of pathogens. One must also observe the breath: fine and long breath is auspicious, while coarse and short breath is critical. During han sweating, no medication should be administered. Tonifying herbs will prevent thorough sweating and retain pathogens, causing harm; draining herbs will fail to support healthy qi, leading to collapse. It is best to provide plenty of hot water to nourish body fluids and assist in sweating. One must quietly wait for the pulse to become calm and the breath to lengthen, indicating safety. Do not panic. After the shivering stops, observe whether residual pathogens remain and treat according to the principles. If the patient becomes terrified and cries out during the expected time of han, the Shen (Spirit) becomes disordered first, allowing pathogens to overcome healthy qi, turning into a critical condition that is untreatable.
Generally, Wind-Cold pathogens move from the exterior to the interior, so han sweating is rare. Damp-Heat pathogens move from the interior to the exterior, so han sweating is common. After han sweating, if the pulse is calm, the body is cool, the tongue coating has cleared, the chest and abdomen are unobstructed, and appetite gradually returns, this signifies complete resolution. Otherwise, if residual pathogens remain and fever recurs, the patient may experience another episode of han sweating to resolve, or even three to four episodes. Resolution always depends on the interior conditions. Sometimes, after the shivering subsides, the patient falls into a deep sleep, appearing lifeless. Observe the pulse; if it remains gentle and rooted, do not be alarmed. The patient will wake once Qi recovers. Occasionally, the pulse may temporarily stop; check the respiration. If breathing is still long, this is known as "Mai Jue" (Pulse Syncope), which will recover naturally over time; do not be alarmed.
Although resolution after shivering is a good omen, if the patient presents with a rapid pulse, coarse breathing, numbness of the body, inability to take food or drink, fixed gaze, and a flaccid tongue unable to speak, these are signs of impending collapse, not resolution through han sweating.
Han sweating does not result from sweating therapy. If a disease is suitable for sweating therapy, the pathogen is in the exterior, and sweating will occur naturally without waiting for shivering. Han sweating occurs because the pathogen moves from the interior to the exterior. Therefore, one often sees formulas containing cooling and purgative herbs, with absolutely no exterior-releasing drugs, yet the patient naturally resolves through han sweating. This results from the communication between the interior and exterior, and the harmony of Yin and Yang, occurring naturally rather than being forced by external means.