门人问曰。内经言冬伤于寒。春必病温。又言冬不藏精。春必病温。仲景但言温病。并
未指
明春温。温病果专属春时发乎。答曰。冬三月此谓闭脏。古圣人顺冬气以养脏。使志若伏若
匿。若有私意。若已有得。去寒就温。无泄皮肤。使气亟夺。此养脏之道。预为来春奉生地
步
。故月令先王以至日闭关。商旅不行。后不省方。诚慎之也。冬伤于寒者。以无固密居室之
功。致泄皮肤而寒气内薄。然当其时不即病。感春月之温气始发。肌肤乃阳明胃经之所主。
寒毒藏于肌肤。阳明经中久郁之邪。一旦发出而外达于太阳。是由阳明而太阳。不尽由太阳
而阳明少阳。故与风寒之邪由表入里者。治法不同。然此犹病温之轻者。若冬不藏精之温病
。则更不守闭脏之令。数犯房室。其人肾水先亏。一遇温邪感触。乘虚直入。遂有勃然不可御之
势。此邪往往直入少阴。更不得以太阳论治。大凡冬伤于寒之温病。病在太阳。即当急存胃
中之津液。冬不藏精之温病。病入少阴。尤当急顾肾中之津液。至谓病温必在春时。则四时
之中。非其时有其气者。当亦不免。即如内经言秋伤于湿。冬生咳嗽。岂咳嗽必在冬时耶。
故仲景大法。断不泥四时言病也。
门人问曰。有病温而反宜用温药愈者。何也。答曰。此正仲景所指伏气之为病。仲景云
。伏气之病。当须脉之。若脉微弱者。当喉中痛。似伤。非喉痹也。病患云。实喉中痛。虽尔。今
复欲
下利。按喉痹一证。多由温邪郁结三阳。宜按阳经论治。今咽中虽痛。似伤而非真伤。又脉
见微弱。则病不在太阳阳明而在少阴。冬不藏精之人。少阴肾脏。先已自病。少阴之脉夹咽
。故为咽痛。阳僭于上。阴亦无以自固。故虽咽痛。热必复作下利。咽痛复下利。此为少阴
证。若误作喉痹而以阳经论治。亡可立待矣。更有身体灼热。绝。似阳经表证。而脉见微弱且多
杂以少阴证者。是内挟真寒。外显假热。误进寒凉。即速其毙。凡此皆当急温之证。仲景大
法
。森森俱列。同一病温。而阴阳寒热。判然不同。藉非脉法辨别真确。毫厘千里。几何不为疑似所惑哉。
弟子问道：“《内经》说‘冬季感受寒邪，春季必定发生温病’，又说‘冬季肾精不藏，春季必定发生温病’。张仲景只论述了温病，并没有明确指出‘春温’。温病果然专门是在春季发作的吗？”
回答说：“冬三月叫做闭藏之季。古代的圣人顺应冬季的气候来养护脏气，使情志像潜伏、隐匿一样，好像有私密的意图，好像已经有所收获。远离寒冷，靠近温暖，不要使皮肤开泄，以免阳气频繁耗夺。这是养护脏气的道理，是为来年春天奉养生机做准备。所以《月令》记载先王在冬至日关闭关卡，商旅不行走，君主也不巡视四方，确实是十分谨慎啊。所谓‘冬伤于寒’，是因为没有坚固密闭居室的功效，导致皮肤开泄而寒气内迫。然而在当时并不立即发病，等到感受春季的温热之气才发作。肌肤是阳明胃经所主司的部位。寒毒潜伏在肌肤之中，阳明经中久郁的邪气，一旦发出并外达于太阳经。这是由阳明经传至太阳经，并不完全是由太阳经传入阳明、少阳经。因此，与风寒之邪由表入里的治法不同。但这还是属于温病中较轻的情况。如果是‘冬不藏精’导致的温病，就更不遵守闭藏的法则，多次犯房事，此人的肾水先已亏损，一遇到温邪感触，便乘虚直入，于是呈现出勃然不可抵御的态势。这种邪气往往直接侵入少阴经，更不能按照太阳经来论治。大凡‘冬伤于寒’的温病，病位在太阳经，就应当紧急保存胃中的津液；‘冬不藏精’的温病，病位深入少阴经，尤其应当紧急顾护肾中的津液。至于说温病一定在春季发作，那么在四时之中，如果不是那个季节却出现了那个季节的气候（非时之气），也难免患病。就像《内经》所说‘秋季感受湿邪，冬季产生咳嗽’，难道咳嗽一定发生在冬季吗？所以张仲景的大法，绝不会拘泥于四季来谈论疾病。”
弟子又问道：“有的温病患者反而适宜用温药治愈，为什么呢？”
回答说：“这正是张仲景所指出的伏气致病。张仲景说：‘伏气之病，必须诊察脉象。如果脉象微弱，应当出现咽喉疼痛，看似受伤，但不是喉痹。’病人说：‘确实是咽喉疼痛。虽然如此，现在又想腹泻。’按喉痹这一证候，多由温邪郁结在三阳经，应当按阳经来论治。现在咽中虽然疼痛，看似受伤却不是真正的受伤，而且脉象见微弱，那么病不在太阳、阳明经，而在少阴经。冬季肾精不藏的人，少阴肾脏先已自病。少阴经的经脉夹行于咽喉，所以出现咽痛。阳气僭越于上，阴气也无法自我固守，所以虽然咽痛，热势必然再次引发下利。咽痛伴随下利，这是少阴证的典型表现。如果误认为是喉痹而按阳经论治，死亡就在眼前了。更有身体灼热，完全类似阳经表证，但脉象微弱且多夹杂少阴证表现的，这是内挟真寒，外显假热。误进寒凉药物，就会加速死亡。凡是这些情况，都应当紧急使用温法治疗。张仲景的大法，严谨地罗列于此。同样是温病，阴阳寒热的性质判然不同。如果不是通过脉法辨别真伪准确无误，失之毫厘谬以千里，多少不会被疑似症状所迷惑呢？”
The disciple asked, "The *Neijing* states that 'if one is injured by cold in winter, one will inevitably suffer from warm disease in spring,' and also that 'if one fails to store essence in winter, one will inevitably suffer from warm disease in spring.' Zhang Zhongjing only discusses warm disease (Wenbing, febrile diseases caused by warm pathogens) but does not explicitly specify 'Spring Warmth' (Chunwen). Is warm disease exclusively occurring in the spring season?"
The answer was, "The three months of winter are called the period of closure and storage. The ancient sages followed the qi of winter to nourish the zang organs, keeping their intentions as if hidden or concealed, as if having private thoughts, as if already satisfied. They avoided cold and sought warmth, preventing the skin from opening and sweating, so that qi would not be frequently depleted. This is the way to nourish the zang organs, preparing the foundation for the generation of life in the coming spring. Therefore, the *Yueling* records that the former kings closed the passes on the day of the Winter Solstice, merchants did not travel, and rulers did not inspect the regions, which was indeed a matter of great caution. Regarding 'injury by cold in winter,' it occurs because one lacks the efficacy of living in solid and sealed dwellings, leading to open pores and internal encroachment of cold qi. However, at that time, the disease does not manifest immediately; it erupts only after being affected by the warm qi of spring. The skin and muscles are governed by the Yangming Stomach Meridian. Cold toxin hides within the skin and muscles, and the pathogenic factors long stagnating in the Yangming meridian, once released, reach outward to the Taiyang meridian. Thus, it proceeds from Yangming to Taiyang, not entirely from Taiyang to Yangming and Shaoyang. Therefore, its treatment differs from wind-cold pathogens entering from the exterior to the interior. However, this is still considered a mild form of warm disease. If it is warm disease due to 'failure to store essence in winter,' one violates the law of closure even more, engaging in sexual activity frequently. In such individuals, kidney water is deficient first. Upon contact with warm pathogens, the evil enters directly through the deficiency, presenting an unstoppable momentum. Such pathogens often enter directly into the Shaoyin meridian and cannot be treated according to the Taiyang meridian. Generally speaking, for warm disease due to 'injury by cold in winter,' where the pathology is in the Taiyang meridian, one must urgently preserve the fluids in the stomach. For warm disease due to 'failure to store essence in winter,' where the pathology has entered the Shaoyin meridian, one must especially urgently protect the fluids in the kidneys. As for the claim that warm disease must occur in spring, in the four seasons, if there is qi inappropriate to the season, illness is inevitable. Just as the *Neijing* says 'if one is injured by dampness in autumn, cough arises in winter,' does cough necessarily occur only in winter? Therefore, Zhang Zhongjing's general principles never rigidly adhere to the four seasons when discussing disease."
The disciple asked again, "There are cases of warm disease that are appropriately cured using warm medicines. Why is this?"
The answer was, "This precisely refers to the disease caused by latent qi indicated by Zhang Zhongjing. Zhang Zhongjing said: 'For disease caused by latent qi, one must palpate the pulse. If the pulse is weak and faint, there should be pain in the throat, resembling injury, but it is not Hou Bi (sore throat/tonsillitis).' The patient says, 'Indeed, there is severe throat pain. Although so, now I also desire diarrhea.' According to the syndrome of Hou Bi, it is mostly caused by warm pathogens stagnating in the Three Yang meridians and should be treated according to the Yang meridians. Now, although there is pain in the pharynx, it resembles injury but is not true injury, and the pulse appears weak and faint, indicating that the disease is not in the Taiyang or Yangming meridians but in the Shaoyin meridian. In individuals who failed to store essence in winter, the Shaoyin Kidney organ is already diseased. The Shaoyin meridian runs alongside the throat, hence the throat pain. Yang qi rebels upward, and Yin qi cannot consolidate itself, so although there is throat pain, heat will inevitably trigger diarrhea again. Throat pain accompanied by diarrhea constitutes a Shaoyin syndrome. If mistakenly diagnosed as Hou Bi and treated according to the Yang meridians, death will follow immediately. Furthermore, there are cases where the body is burning hot, completely resembling an exterior syndrome of the Yang meridians, yet the pulse is weak and faint and often mixed with Shaoyin symptoms. This indicates internal true cold with external false heat. Administering cold and cooling herbs will accelerate death. All these situations require urgent warming treatment. Zhang Zhongjing's general principles are rigorously listed here. The same warm disease presents with clearly distinct yin and yang, cold and heat natures. Unless the pulse diagnosis accurately distinguishes truth from falsehood, a slight error leads to a huge discrepancy. How many would not be confused by similar-looking symptoms?"