庞曰∶《素问》云∶冬三月是谓闭藏，水冰地裂，无扰乎阳。又云∶彼春之暖，为夏之暑；彼
秋之忿，为冬之怒，是以严寒冬令，为杀厉之气也。故君子善知摄生，当严寒之时，周密居室而不
犯寒毒，其有奔驰荷重，劳房之人，皆辛苦之徒也。当阳气闭藏，反扰动之，令郁发腠理，津液强
渍，为寒所搏，肤腠反密，寒毒与荣卫相浑。当是之时，勇者气行则已，怯者则着而成病矣。其即
时成病者，头痛身疼，肌肤热而恶寒，名曰伤寒。其不实时成病，则寒毒藏于肌肤之间，至春夏阳
气发生，则寒毒与阳气相搏于荣卫之间，其患与冬时即病候无异。因春温气而变，名曰温病也。因
夏暑气而变，名曰热病也。因八节虚风而变，名曰中风也。因暑湿
而变，名曰湿病也。因气运风热相搏而变，名曰风温也。其病本因冬时中寒，随时有变病之形态尔，
故大医通谓之伤寒焉。其暑病、湿温、风温死生不同，形状各异，治别有法。
庞曰∶天寒之所折，则折阳气。足太阳为诸阳主气，其经夹脊膂，贯五脏六腑之 ，上入脑，
故始则太阳受病也。以其经贯五脏六腑之 ，故病有脏腑传变之候。以其阳经先受病，故次第传入
阴经。以阳主生，故足太阳水传足阳明土，土传足少阳木，为微邪。以阴主杀，故木传足太阴土，
土传足少阴水，水传足厥阴木。至第六七日，当传足厥阴肝，木必移气克于脾土，脾再受贼邪，则
五脏六腑皆危殆矣。荣卫不通，耳聋囊缩，不知人则死，速用承气汤下之，（方在可下证中。）则
可保五死一生。勿从容拯溺，病患水浆不入，汤液不下，无可奈何也。《素问》云∶脾热病则五脏
危。又云∶土败木贼则死。若第六七日传厥阴，脉得微缓、微浮，其证寒热似疟，此为必愈，宜桂
枝麻黄各半汤和之。（方在可汗证中。）微缓、微浮为脾胃脉也，故知脾气全不再受克，邪无所容，
否极泰来，荣卫将复，水升火降，则寒热作而大汗解矣。人将大汗必冒昧者，若久旱天将时雨，六
合皆至昏昧。雨降之后，草木皆苏，庶物明净，《玉
册》所谓换阳之吉证也。
王叔和云∶土地温凉，高下不同，物性刚柔，餐居亦异。是以黄帝兴四方之问，歧伯立四治之
能，以训后贤，开其未悟。临病之工，宜两审之。
庞曰∶叔和非医之圆机，孰能臻此也。如桂枝汤自西北二方居人，四时行之，无不应验。自江
淮间地偏暖处，唯冬及春可行之。自春末及夏至以前，桂枝、麻黄、青龙内宜黄芩也。自夏至以后，
桂枝内又须随证增知母、大青、石膏、升麻辈取汗也。若时行寒疫及病患素虚寒者，正用古方，不
在加减矣。夏至以后，虽宜白虎，详白虎汤自非新中 而变暑病所宜，乃汗后解表药耳，以白虎未
能驱逐表邪故也。或有冬及始春寒甚之时，人患斯疾，因汗下偶变狂躁不解，须当作内热治之，不
拘于时令也。南方无霜雪之地，不因寒气中人，地气不藏，虫类泄毒，岚瘴间作，不在此法，治别
有方也。又一州之内，有山居者为居积阴之所，盛夏冰雪，其气寒，腠理闭，难伤于邪，其人寿，
其有病者多中风中寒之疾也。有平居者为居积阳之所，
严冬生草，其气温，腠理疏，易伤于邪，其人夭，其有病者多中湿中暑之疾也。凡人禀气各有盛衰，
宿病各有寒热。因伤寒蒸起宿疾，更不在感异气而变者。假令素有寒者，多变阳虚阴盛之疾，或变
阴毒也。素有热者，多变阳盛阴虚之疾，或变阳毒也。
庞曰∶四时之中，有寒暑燥湿风火相搏，喜变诸疾，须预察之。其饮食五味禽鱼虫菜果实之属，
性偏有嗜者；或金石草木药素尝有饵者；人五脏有大小、高下、坚脆、端正偏倾，六腑亦有大小、
长短、浓薄、缓急，令人终身长有一病者。贵者后贱，富者乍贫，有常贵，有常富，有暴富，有暴
贫，有暴乐，有暴苦，有始乐后苦，有离绝蕴结，忧恐喜怒者。夫常贵后贱，名曰脱营；常富后贫，
名曰失精。暴乐暴苦，始乐后苦，精竭体沮，脱势侯王，精神内伤，情慕尊贵，妄为丧志。始富后
贫，焦皮挛筋，常富恶劳，骄堕精消。离间亲爱者魂游绝，所怀者意丧，所虑者神劳，结怨恨者志
苦，忧愁者闭塞而不行，盛怒者迷惑而不治，恐惧者荡惮而不收，喜乐者掸散而不藏，此皆非外邪
所中而得之于内也。良工必预审问其由，先知脏腑经络受病之所，可举万全。粗工不思晓，令五脏
六腑血气离守，迨至不救，又何言哉。
庞曰∶阴阳虚盛者，非谓分尺寸也。荣卫者，表阳也。肠胃者，里阴也。寒毒争于荣卫之中，
必发热恶寒，尺寸俱浮大，内必不甚躁。设有微烦，其人饮食欲温而恶冷，谓阳虚阴盛也，可汗之
则愈，若误下则死也。若寒毒相搏于荣卫之内，而阳盛阴衰，极阴变阳，寒盛生热，热气盛而入里，
热毒居肠胃之中，水液为之干涸，燥粪结聚。其人外不恶寒，必蒸蒸发热而躁，甚则谵语。其脉浮
滑而数，或洪实，或汗后脉虽迟，按之有力，外证已不恶寒，腹满而喘，此皆为阳盛阴虚，当下之
则愈，若误汗则死也。仲景载三等阳明，是阳盛阴虚证矣。调经论云∶阳虚则外寒，阴虚则内热，
阳盛则外热，阴盛则内寒，以此别之。若阴独盛而阳气暴绝，必四肢逆冷，脐筑腠痛，身疼如被杖，
面青，或吐，或利，脉细欲绝，名曰阴毒也。须急灸脐下，服以辛热之药，令阳气复生， 然汗出
而解。若阳独盛而阴气暴绝，必发躁，狂走妄言，面赤咽痛，身斑斑如锦文。或下利赤黄，脉洪实
或滑促，名曰阳毒也。宜用针泄热，服以苦酢之药，令阴气复生， 然汗出而解也。
庞曰∶夫邪逆阴阳之气，非汗不能全其天真。《素问》云∶辛甘发散为阳，谓桂
枝、甘草、细辛、姜枣、附子之类，能复阳气也。酸苦涌泄为阴，谓苦参、大青、葶苈、苦酒、艾
之类，能复阴气也。酸苦之药，既折热复阴亦当小汗而后利者。经云∶身汗得而后利，则实者可活
是也。
华佗治法云∶伤寒病起自风寒入于腠理，与精气分争，荣卫痞膈，周行不通。病一日至二日，
气在孔窍皮肤之间，故病者头痛恶寒，身热，腰背强重，此邪气在表，随证发汗则愈。
庞曰∶凡发汗，须如常覆腰以上，浓衣覆腰以下，以腰足难取汗故也。半身无汗，病终不解。
凡发汗后，病证仍存，于三日内，可二三发汗，令腰脚周遍为度。若病不解，便可下之。设令下后
不解，表里邪亦衰矣，足观脉证调治，七日内可期正汗为善也。发汗后不可再行汗者，始发热恶寒，
今不恶寒，但倍发热而躁；始脉浮大，今洪实，或沉细数；始惺静，今狂语；此胃实阳盛，再行汗
药即死，须当下之。有人始得病变阳盛之证，须便下之，不可拘日子深浅次第也。病三日以上，气
浮上部，填塞胸膈，故头痛胸中满，或多痰涎，当吐之则愈。
庞曰∶若虚损及新产人不能吐者，可服枳实散。（枳实细末，米饮调二钱，日可三四服。）
若有虚寒，手足冷及脉微弱者，枳实二两加桂枝一两，同末之，如前服。
病五六日以上，气结在脏腑，故腹满身重，骨节烦疼，当下则愈。若小便少，手足心并腋下不
滋润，尚未可攻之，当消息其候，不可乱投汤药，虚其胃气也。（以上解华佗治法。）
庞安石说：《素问》记载：冬季的三个月称为闭藏，此时水结冰、地开裂，不要扰动阳气。又说：那里的春天的温暖，造就了夏天的暑热；那里的秋天的肃杀（忿），造就了冬天的严寒（怒），因此严冬的寒令，是产生杀厉之气的原因。所以善于养生的人，在严寒之时，应周密地居住在室内而不触犯寒毒，那些骑马奔驰、背负重物、房劳过度的人，都是辛苦劳作之徒。当阳气闭藏时，反而去扰动它，使阳气郁结发散于腠理，津液强行浸渍，被寒气搏结，导致皮肤腠理反而密闭，寒毒与营卫之气混杂在一起。在这个时候，体质强健的人，气机通畅则病愈；体质虚弱的人，邪气停留而发病。当时即发病的，出现头痛身疼，肌肤发热且恶寒，名叫伤寒。当时不立即发病，寒毒潜伏在肌肤之间，到了春夏季节阳气生发时，寒毒与阳气在荣卫之间相搏结，其病症表现与冬季即时发病的症状没有不同。因春季温热之气影响而变化的，名叫温病。因夏季暑热之气影响而变化的，名叫热病。因八节虚风影响而变化的，名叫中风。因暑湿影响而变化的，名叫湿病。因气运风热相搏结而变化的，名叫风温。这些病的本源都是因为冬季感受了寒邪，随着时节变化而有不同的病态表现，所以大医通称它们为伤寒。其中暑病、湿温、风温的死生预后不同，症状形态各异，治疗有专门的方法。
庞安石说：天寒损伤人体，首先折损的是阳气。足太阳膀胱经是诸阳经的主气，它的经脉夹行于脊柱两旁，贯通五脏六腑的背俞穴，上行入脑，所以疾病开始是太阳经受病。因为它的经脉贯通五脏六腑的背俞穴，所以疾病有脏腑传变的征候。因为阳经先受病，所以依次传入阴经。以阳主生发，所以足太阳水传给足阳明土，土传给足少阳木，这是微邪。以阴主肃杀，所以木传给足太阴土，土传给足少阴水，水传给足厥阴木。到了第六七日，应当传到足厥阴肝，木气必然移气克制脾土，脾再次受到贼邪侵袭，那么五脏六腑都危险了。如果营卫不通，出现耳聋、囊缩、神志不清，就会死亡，必须迅速用承气汤攻下，（方剂在可下证中。）则可以保全五死一生中的那一线生机。不要从容不迫地像救溺水者一样拖延，如果病患连水浆都进不去，汤药也喂不下，那就无可奈何了。《素问》说：脾热病则五脏危殆。又说：土败木贼则死。如果第六七日传到厥阴，脉象得到微缓、微浮，症状表现为寒热往来像疟疾，这是必定痊愈的征兆，适宜用桂枝麻黄各半汤调和。（方剂在可汗证中。）微缓、微浮是脾胃的脉象，所以知道脾气完全不再受克伐，邪气无处容身，否极泰来，营卫将要恢复，水升火降，那么寒热发作后大汗出而解。人将要大汗出时必定会有头目昏眩的感觉，就像久旱之后天将下雨，天地四方都变得昏暗不明。雨降之后，草木复苏，万物明净，《玉册》所说的换阳的吉兆。
王叔和说：土地有温凉之分，高低不同，物性有刚柔之别，饮食居住也有差异。因此黄帝向四方询问，歧伯确立了四种治理的能力，用来教导后来的贤者，开启他们未悟之处。临证治疗的医生，应该两方面都审察清楚。
庞安石说：如果不是精通医道的圆机之士，谁能达到这种境界呢？比如桂枝汤，对于西北两方居住的人，四季使用，无不灵验。对于江淮之间地势偏暖的地方，只有冬季和春季可以使用。从春末到夏至以前，桂枝、麻黄、青龙汤内部适宜加入黄芩。从夏至以后，桂枝汤内又须根据症状增加知母、大青、石膏、升麻等药来取汗。如果是时行寒疫以及病患平素体虚寒的，正用古方，不在加减之列。夏至以后，虽然适宜用白虎汤，但详细考察白虎汤并非新感暑邪而变成的暑病所适宜，它是汗后解表的药物罢了，因为白虎汤不能驱逐表邪的缘故。或者在冬季及初春寒冷很甚的时候，有人患此病，因为汗法或下法偶然导致狂躁不解，必须当作内热来治疗，不拘泥于时令。南方无霜雪的地方，不因寒气中人，地气不闭藏，虫类泄毒，岚瘴间作，不在此法范围内，治疗另有方子。又一州之内，有山居的人是居住在积阴之所，盛夏仍有冰雪，其气寒，腠理密闭，难伤于邪气，这样的人长寿，如果有病，多是中风、中寒的疾病。有平居的人是居住在积阳之所，严冬仍能生草，其气温，腠理疏松，易伤于邪气，这样的人短寿，如果有病，多是中湿、中暑的疾病。凡人禀受的气各有盛衰，宿疾各有寒热。因伤寒蒸腾而起宿疾，更不在于感受异气而变化。假如平素有寒的人，多变为阳虚阴盛的疾病，或变为阴毒。平素有热的人，多变为阳盛阴虚的疾病，或变为阳毒。
庞安石说：四季之中，有寒暑燥湿风火相搏结，喜欢变化出各种疾病，必须预先察知。那些饮食五味、禽鱼虫菜果实之类，性味偏颇且有嗜好的人；或者金石草木药素常服用的人；人的五脏有大小、高下、坚脆、端正偏倾的不同，六腑也有大小、长短、浓薄、缓急的差异，使人终身常有一种病。尊贵者后来变得卑贱，富有者突然变得贫穷，有常贵，有常富，有暴富，有暴贫，有暴乐，有暴苦，有始乐后苦，有离绝蕴结，忧恐喜怒的情况。经常尊贵后来卑贱，名叫脱营；经常富有后来贫穷，名叫失精。暴乐暴苦，始乐后苦，精气枯竭身体沮丧，脱离势位侯王，精神内伤，情慕尊贵，妄为丧志。始富后贫，焦皮挛筋，常富厌恶劳累，骄傲堕落精消。离间亲爱的人魂游意散，所怀恋者意志丧失，所忧虑者神劳，结怨恨者志苦，忧愁者闭塞而不行，盛怒者迷惑而不治，恐惧者荡惮而不收，喜乐者掸散而不藏，这些都不是外邪所中，而是得之于内部的。良工必定预先审问其原因，先知脏腑经络受病的地方，可以万无一失。粗工不思量知晓，致使五脏六腑血气离守，等到无法救治，又有什么话可说呢。
庞安石说：阴阳虚盛，不是说分尺寸脉。营卫，是表阳。肠胃，是里阴。寒毒争于荣卫之中，必定发热恶寒，尺寸脉俱浮大，内部必定不甚躁动。假设有轻微烦躁，其人饮食想喝温的而厌恶冷的，这叫阳虚阴盛，可以用汗法治愈，如果误用下法就会死亡。如果寒毒相搏于荣卫之内，而阳盛阴衰，极阴变阳，寒盛生热，热气盛而入里，热毒居于肠胃之中，水液为之干涸，燥粪结聚。其人外部不恶寒，必定蒸蒸发热而躁动，甚至谵语。其脉浮滑而数，或洪实，或汗后脉虽迟，按之有力，外部症状已不恶寒，腹满而喘，这些都是阳盛阴虚，当下之则愈，如果误用汗法就会死亡。仲景记载三等阳明病，就是阳盛阴虚证了。《调经论》说：阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒，以此区别。如果阴独盛而阳气暴绝，必定四肢逆冷，脐筑腠痛，身疼如被杖打，面青，或吐，或利，脉细欲绝，名叫阴毒。必须紧急灸脐下，服用辛热的药物，令阳气复生，濈然汗出而解。如果阳独盛而阴气暴绝，必定发躁，狂走妄言，面赤咽痛，身斑斑如锦纹。或下利赤黄，脉洪实或滑促，名叫阳毒。适宜用针泄热，服用苦酢的药物，令阴气复生，濈然汗出而解。
庞安石说：邪气逆乱阴阳之气，不用汗法不能完全保全天真之气。《素问》说：辛甘发散为阳，指桂枝、甘草、细辛、姜枣、附子之类，能恢复阳气。酸苦涌泄为阴，指苦参、大青、葶苈、苦酒、艾之类，能恢复阴气。酸苦的药物，既折热复阴，也应当小汗而后利者。经文说：身汗得而后利，则实者可活，就是这个意思。
华佗治法说：伤寒病起自风寒侵入腠理，与精气分争，营卫痞膈，周行不通。病一日至二日，气在孔窍皮肤之间，所以病人头痛恶寒，身热，腰背强重，这是邪气在表，随证发汗则愈。
庞安石说：凡是发汗，须像平常一样覆盖腰部以上，用厚衣覆盖腰部以下，因为腰脚难以取汗的缘故。半身无汗，病终不解。凡是发汗后，病证仍存在，在三日内，可以二三度发汗，以腰脚周身出汗为度。如果病不解，就可以用下法。假设下后不解，表里邪气也已衰减了，足以观察脉证调治，七日内期待正汗出为善。发汗后不可再行汗法的，开始发热恶寒，现在不恶寒，只是加倍发热而躁动；开始脉浮大，现在洪实，或沉细数；开始清醒安静，现在狂语；这是胃实阳盛，再行汗药即死，必须当下之。有人刚开始病变为阳盛之证，须立即下之，不可拘泥于日子深浅次第。病三日以上，气浮上部，填塞胸膈，所以头痛胸中满，或多痰涎，当用吐法则愈。
庞安石说：如果是虚损及新产之人不能吐的，可以服用枳实散。（枳实细末，米饮调服二钱，每日可服三四次。）如果有虚寒，手足冷及脉微弱者，枳实二两加桂枝一两，同研为末，像前面那样服用。
病五六日以上，气结在脏腑，所以腹满身重，骨节烦疼，当下之则愈。如果小便少，手足心并腋下不滋润，尚未可攻之，应当斟酌其候，不可乱投汤药，以免虚其胃气。（以上解释华佗治法。）
Pang Anshi said: The *Suwen* (Basic Questions) states: The three months of winter are called "closing and storing" (Bi Cang). At this time, water freezes and the earth cracks; one should not disturb the Yang Qi. It also states: The warmth of spring there brings about the heat of summer; the severity of autumn there brings about the anger (cold) of winter. Therefore, the severe cold of winter is the source of killing and harsh Qi. Thus, a gentleman who is good at preserving life should, during times of severe cold, reside in well-sealed rooms to avoid invading cold pathogens. Those who ride swiftly, carry heavy loads, or engage in excessive sexual activity are all those who endure hardship. When Yang Qi is closed and stored, disturbing it causes it to become stagnant and then disperse into the Cou Li (interstitial spaces), forcing fluids to soak through. If combated by cold, the skin and Cou Li become tight, and cold pathogens mix with Ying (Nutritive) and Wei (Defensive) Qi. At this time, those with strong constitution recover as Qi flows smoothly; those with weak constitution develop disease as pathogens attach. Those who fall ill immediately present with headache, body ache, hot skin, and aversion to cold, named Shang Han (Cold Damage). Those who do not fall ill immediately harbor cold pathogens between the skin and muscles. When Yang Qi arises in spring and summer, the cold pathogens combat with Yang Qi between Ying and Wei. Their symptoms are no different from those who fell ill immediately in winter. If changed by the warm Qi of spring, it is named Wen Bing (Warm Disease). If changed by the summer heat Qi, it is named Re Bing (Heat Disease). If changed by the empty winds of the eight seasonal transitions, it is named Zhong Feng (Wind Strike). If changed by summer dampness, it is named Shi Bing (Damp Disease). If changed by the combat of Qi movement, wind, and heat, it is named Feng Wen (Wind Warmth). The root of these diseases lies in contracting cold in winter, manifesting differently according to the season. Therefore, great physicians collectively call them Shang Han. Among them, Shu Bing (Summer Heat Disease), Shi Wen (Damp Warmth), and Feng Wen have different prognoses and distinct manifestations, requiring specific treatments.
Pang Anshi said: Heavenly cold injures the body by first damaging Yang Qi. Foot-Taiyang (Bladder Meridian) governs the Qi of all Yang meridians. Its channel runs alongside the spine, penetrates the Back-Shu points of the Zang-Fu organs, and enters the brain. Thus, disease begins with Taiyang involvement. Because its channel connects the Back-Shu points of the Zang-Fu, diseases exhibit transmission patterns among Zang-Fu. Since Yang meridians are affected first, the disease sequentially transmits to Yin meridians. Yang governs generation; thus, Foot-Taiyang Water transmits to Foot-Yangming Earth, and Earth transmits to Foot-Shaoyang Wood, representing minor pathogens. Yin governs destruction; thus, Wood transmits to Foot-Taiyin Earth, Earth to Foot-Shaoyin Water, and Water to Foot-Jueyin Wood. By the sixth or seventh day, transmission reaches Foot-Jueyin Liver. Wood Qi inevitably overacts on Spleen Earth. If the Spleen suffers again from thief pathogens, the Zang-Fu organs face danger. If Ying and Wei circulation stops, accompanied by deafness, retraction of the scrotum, and unconsciousness, death ensues. One must urgently administer Chengqi Tang (Cassia Decoction) to purge (see Purge Syndrome section for formula); this may save one out of five deaths. Do not hesitate like saving a drowning person; if the patient cannot swallow liquids or medicine, it is hopeless. The *Suwen* states: Spleen heat disease endangers the five Zang organs. It also states: Earth failure with Wood overacting leads to death. If transmission reaches Jueyin on the sixth/seventh day, and the pulse is slightly slow and floating, with symptoms resembling malaria (alternating chills and fever), recovery is certain. Guizhi Mahuang Ge Ban Tang (Half-Size Decoction of Cinnamon Twig and Ephedra) should be used to harmonize (see Sweating Syndrome section for formula). A slightly slow and floating pulse indicates Spleen-Stomach pulses, meaning the Spleen Qi is no longer suppressed, pathogens have no place to reside, adversity turns to prosperity, Ying and Wei will recover, Water rises and Fire descends. After chills and fever occur, profuse sweating resolves the condition. Before profuse sweating, patients often experience dizziness, like the gloom before rain after a long drought. After rain, vegetation revives, and things become clear, which the *Yuce* calls a auspicious sign of changing Yang.
Wang Shuhe said: Land varies in temperature and altitude; objects differ in rigidity and softness; diet and residence vary accordingly. Thus, the Yellow Emperor inquired widely, and Qibo established four methods of treatment to instruct later generations and clarify misunderstandings. Practitioners must examine both aspects.
Pang Anshi said: Only a master with flexible wisdom could achieve this. For example, Guizhi Tang (Cinnamon Twig Decoction) works effectively in all seasons for people in the northwest. In the warmer Jianghuai region, it is only suitable for winter and spring. From late spring to before Summer Solstice, Huangqin (Scutellaria Root) should be added to Guizhi, Mahuang, and Qinglong formulas. After Summer Solstice, Zhimu (Anemarrhena Rhizome), Daqing (Isatis Leaf), Shigao (Gypsum Fibrosum), and Shengma (Cimicifuga Rhizome) should be added to Guizhi Tang to induce sweating. For epidemic cold pathogens or patients with chronic deficiency-cold, ancient formulas are used without modification. Although Baihu Tang (White Tiger Decoction) is suitable after Summer Solstice, it is not intended for new-onset summer heat diseases but rather for resolving exterior conditions after sweating, as it cannot expel exterior pathogens. In deep winter or early spring, if a patient becomes manic and restless due to improper sweating or purging, treat as internal heat regardless of the season. In southern regions without frost or snow, where cold does not invade directly, and local Qi does not store, insect toxins and mountain miasmas arise; these require different treatments. Within a prefecture, mountain dwellers live in Yin-accumulating areas with ice/snow even in midsummer. Their Cou Li are closed, making them resistant to pathogens and long-lived; their illnesses are mostly Zhong Feng (Wind Strike) or Zhong Han (Cold Strike). Plain dwellers live in Yang-accumulating areas where grass grows in winter. Their Cou Li are loose, making them susceptible to pathogens and short-lived; their illnesses are mostly Zhong Shi (Damp Strike) or Zhong Shu (Summer Heat Strike). Individuals vary in constitutional strength and chronic conditions (cold/heat). Shang Han can trigger chronic diseases, independent of new pathogenic factors. Those with chronic cold tend toward Yang deficiency/Yin excess or Yin Du (Yin Toxin). Those with chronic heat tend toward Yang excess/Yin deficiency or Yang Du (Yang Toxin).
Pang Anshi said: In the four seasons, cold, heat, dryness, dampness, wind, and fire interact, causing various diseases, which must be anticipated. Dietary preferences (five flavors, meat/fish/vegetables/fruits) with extreme tastes, or habitual use of mineral/plant medicines, contribute to disease. The five Zang organs vary in size, position, firmness, and alignment; the six Fu organs vary in size, length, thickness, and tension, predisposing individuals to lifelong diseases. Changes in social status (noble to lowly, rich to poor, sudden joy/sorrow, separation/grief, fear/anger) cause internal injury. "Noble to lowly" is named Tuo Ying (Depletion of Ying); "Rich to poor" is named Shi Jing (Loss of Jing). Sudden joy/sorrow or joy turning to sorrow deplete Jing and weaken the body, damaging spirit and ambition. Rich to poor causes emaciation and tendon contraction; proud and lazy rich people lose Jing. Separation from loved ones scatters the Hun (Ethereal Soul); unfulfilled desires exhaust the Yi (Intellect); worry burdens the Shen (Spirit); resentment hardens the Will (Zhi); depression blocks flow; rage causes confusion; fear causes instability; excessive joy scatters Qi without storage. These are internal injuries, not external pathogens. Good physicians must inquire thoroughly to locate the diseased Zang-Fu and meridians. Poor physicians fail to understand, leading to chaotic Qi/Blood and untreatable conditions.
Pang Anshi said: Yin/Yang deficiency/excess refers to more than just pulse positions. Ying and Wei are Exterior Yang; Stomach and Intestines are Interior Yin. Cold pathogens combing within Ying and Wei cause fever and aversion to cold, with floating-large pulses at Cun and Chi positions, and minimal internal restlessness. Mild irritability, preference for warm drinks, and aversion to cold indicate Yang deficiency/Yin excess; sweating cures it, while purging kills. If cold pathogens combat internally, causing Yang excess/Yin deficiency, extreme Yin transforms to Yang, cold generates heat, and heat enters the interior. Heat toxin dries fluids, forming dry feces. Externally, no aversion to cold; internally, steaming fever, agitation, delirium. Pulses are floating-slippery-rapid, or full-solid. Even if pulse is slow post-sweating but forceful on pressure, with abdominal fullness and wheezing, this is Yang excess/Yin deficiency; purging cures it, while sweating kills. Zhang Zhongjing's three types of Yangming disease represent Yang excess/Yin deficiency. The *Tiao Jing Lun* states: Yang deficiency causes exterior cold; Yin deficiency causes interior heat; Yang excess causes exterior heat; Yin excess causes interior cold. If Yin alone is excessive and Yang suddenly fails, limbs turn cold, umbilical pain, body pain like being beaten, cyanosis, vomiting/diarrhea, thready-almost-invisible pulse: this is Yin Du (Yin Toxin). Urgently moxa below the navel and administer acrid-hot herbs to restore Yang, leading to continuous sweating and resolution. If Yang alone is excessive and Yin suddenly fails, restlessness, mania, red face, sore throat, skin spots like brocade, bloody/yellow diarrhea, full-slippery-rapid pulse: this is Yang Du (Yang Toxin). Use acupuncture to drain heat and administer bitter-sour herbs to restore Yin, leading to continuous sweating and resolution.
Pang Anshi said: Pathogens disrupting Yin/Yang Qi require sweating to preserve True Tian Zhen (Heavenly Purity). The *Suwen* states: Acrid-sweet dispersing is Yang (e.g., Guizhi, Gancao, Xixin, Ginger/Jujube, Fuzi) restores Yang Qi. Sour-bitter draining is Yin (e.g., Kushen, Daqing, Tingli, Vinegar, Ai) restores Yin Qi. Sour-bitter drugs that reduce heat and restore Yin should induce slight sweating followed by purging. The classic says: "Sweat first, then purge; excess cases survive."
Hua Tuo's method states: Shang Han begins with Wind-Cold entering Cou Li, competing with Essence-Qi, causing Ying-Wei stagnation. On days 1-2, Qi is in pores/skin, causing headache, aversion to cold, fever, stiff back. This is Exterior syndrome; sweating cures it.
Pang Anshi said: When inducing sweat, cover the upper body normally and the lower body with thick clothes, as legs/feet sweat slowly. Half-body sweating means unresolved disease. If symptoms persist post-sweating, repeat sweating 2-3 times within three days until legs/feet sweat. If unresolved, purge. If still unresolved post-purge, exterior-interior pathogens are weakened; observe pulse/symptoms for seven days for proper sweating. Do not re-sweat if: initial fever/cold now becomes high fever/agitation without cold; pulse changes from floating-large to full-solid or deep-thin-rapid; consciousness changes from calm to delirious. This is Stomach Excess/Yang Excess; re-sweating kills; purging is required. Treat Yang excess immediately regardless of day count. If illness lasts >3 days, Qi floats upward, blocking chest/diaphragm, causing headache/chest fullness/phlegm; vomiting cures it.
Pang Anshi said: For deficiency/newborns unable to vomit, use Zhishi San (Immature Bitter Orange Powder): Zhishi fine powder, mixed with rice water, 2 qian per dose, 3-4 times daily. For deficiency-cold with cold limbs/weak pulse, add 1 liang Guizhi to 2 liang Zhishi, powder, and take as above.
After 5-6 days, Qi knots in Zang-Fu, causing abdominal fullness, heaviness, bone/joint pain; purging cures it. If urine is scant, palms/soles/armpits dry, do not purge yet; observe carefully to avoid damaging Stomach Qi with random herbs. (Above explains Hua Tuo's methods.)