凡感外邪。头痛恶寒发热。而兼咳嗽者。此伤风之重症。伤寒之轻症也。盖肺主皮毛。太阳主一身
之表。原相联属。但兼咳嗽。则邪外传于肺而解。不致传里。故为轻症。主治以手太阴为主。如寒邪
重。则舌润不渴。宜六安煎。加羌活、苏叶之类。汗之。如寒天兼喘。气口脉闭。加麻黄。(肺受寒邪)
如发热头痛咳嗽。外虽恶寒。而口渴舌燥。此肺有火邪。而太阳感寒也。宜羌活、前
胡、桑、杏、羚羊、薄荷、黄芩、贝母、橘红、桔梗之类。外散寒邪。内清肺火。兼喘者。火为寒
郁。麻、杏、甘、石汤妙。(寒包火)
邵评∶开肺即是开太阳。此寒包火正治法。
凡人之胃阳充旺。则风寒之入。只在阳经盘旋。不致直入三阴。若胃阳一亏。则寒中太阳。而太阴脾
经。亦与之同时并受。如发热恶寒。即兼泄泻者是也。必舌润不渴。脉来沉缓。法当温中散寒。宜羌活、
紫苏、浓朴、焦曲、广皮、木香、茯苓、炙草之类。外散寒邪。内和脾胃。俾得微汗利止。身凉而愈。
如感之轻。则寒热泄泻。治法亦同。(伤寒)
胃阳为三阴之障。阳气一虚。则寒邪即能袭入三阴。然肾气不虚。则少阴不致受邪。若肾气一虚。
则坎中之阳。不足以御阴邪。即从太阳而入于肾。凡见太阳表证。而脉沉细。肩背恶寒。大便不实。小便
清白者。此即太阳与少阴俱病。重症也。法当温里散寒。宜桂枝汤加当归、(酒炒)山药、干姜、
独活、细辛、胡桃之类。温肾逐邪。若目戴眼上视。气促而喘。或角弓发痉。尤为危候。景岳所谓太阳
未解。少阴先溃是也。须大温中饮主之。冀其回阳作汗。庶有生机。(伤寒)
凡是感受外邪,出现头痛、恶寒、发热,并且兼有咳嗽症状的,这是伤风的重症,也是伤寒的轻症。因为肺主皮毛,太阳经主一身之表,二者原本相互关联。但既然兼有咳嗽,说明邪气向外传变至肺而得以解除,不会传入体内脏腑,所以属于轻症。治疗以手太阴肺经为主。如果寒邪较重,则舌面湿润且不口渴,适宜使用六安煎,加入羌活、苏叶等药物,通过发汗来治疗。如果是寒冷的天气兼见气喘,且寸口脉象闭伏(摸不到),应加入麻黄。(这是因为肺受到寒邪侵袭)
如果出现发热、头痛、咳嗽,体表虽然怕冷,但是口渴、舌面干燥,这是肺内有火邪,同时太阳经受寒所致。适宜使用羌活、前胡、桑白皮、杏仁、羚羊角、薄荷、黄芩、贝母、橘红、桔梗等药物,以发散体表的寒邪,清泄肺内的火邪。如果兼见气喘,是因为火邪被寒邪郁闭,此时使用麻杏甘石汤非常巧妙。(此为“寒包火”证)
大凡人的胃阳充盛旺盛,那么风寒之邪侵入人体,只会在阳经中盘旋,不会直接传入三阴经。如果胃阳一旦亏损,那么寒邪就会侵犯太阳经,同时太阴脾经也会一并受邪。例如出现发热、恶寒,并且兼有泄泻的情况就是如此。此时必定舌面湿润不口渴,脉象沉缓,治法应当温中散寒,适宜使用羌活、紫苏、厚朴、焦神曲、陈皮、木香、茯苓、炙甘草等药物,以发散体表的寒邪,调和内部的脾胃,使得微微出汗且泄泻停止,身体凉爽而痊愈。如果感邪较轻,表现为寒热交替和泄泻,治疗方法也相同。(属于伤寒范畴)
胃阳是三阴经的屏障。阳气一旦虚弱,寒邪就能袭入三阴经。然而如果肾气不虚,少阴经就不会受到邪气侵害。如果肾气一旦虚弱,那么命门之火(坎中之阳)不足以抵御阴寒邪气,邪气就会从太阳经传入肾脏。凡是见到太阳经表证,同时脉象沉细,肩背部怕冷,大便不成形,小便颜色清白,这就是太阳经与少阴经同时发病,属于重症。治法应当温里散寒,适宜使用桂枝汤加入当归(酒炒)、山药、干姜、独活、细辛、胡桃等药物,以温补肾阳并驱逐邪气。如果出现戴眼(眼球固定上视)、气息急促而气喘,或者角弓反张发生痉挛,更是危重的征象。这就是张景岳所说的太阳病未解,少阴先溃败的情况。必须使用大温中饮来主治,希望它能回阳救逆并促使出汗,这样才可能有生机。(属于伤寒范畴)
Whenever external pathogens are contracted, resulting in headache, aversion to cold, fever, and accompanied by coughing, this is a severe form of wind-cold injury (Shangfeng) but a mild form of cold damage (Shanghan). This is because the Lung governs the skin and hair, while the Taiyang channel governs the exterior of the entire body; originally, they are interconnected. However, since coughing is present, it indicates that the pathogen transmits outward to the Lung and is resolved, preventing transmission into the interior organs; thus, it is considered a mild condition. Treatment should primarily focus on the Hand-Taiyin Lung channel. If the cold pathogen is heavy, manifesting as a moist tongue without thirst, Liu'an Decoction (Six-Safe Decoction) is appropriate, added with herbs such as Qianghuo (Notopterygii Rhizoma et Radix) and Ziyeh (Perillae Folium), to induce sweating. If it occurs in cold weather accompanied by wheezing, and the radial pulse at the cunkou position is closed (imperceptible), Mahuang (Ephedrae Herba) should be added. (This is due to the Lung being invaded by cold pathogen.)
If fever, headache, and cough occur, and although there is aversion to cold externally, there is thirst and a dry tongue, this indicates fire pathogen in the Lung combined with cold invasion of the Taiyang channel. It is suitable to use herbs such as Qianghuo (Notopterygii Rhizoma et Radix), Qianhu (Peucedani Radix), Sangbaipi (Mori Cortex), Xingren (Armeniacae Semen Amarum), Lingyangjiao (Saigantong Cornu), Bohe (Menthae Haplocalycis Herba), Huangqin (Scutellariae Radix), Beimu (Fritillariae Bulbus), Juhong (Citri Reticulatae Pericarpium Rubrum), and Jiegeng (Platycodonis Radix) to disperse cold pathogen from the exterior and clear Lung fire from the interior. If accompanied by wheezing, it is because fire is constrained by cold; in this case, Mahxing Ganshi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is excellent. (This is the "Cold Wrapping Fire" pattern.)
Commentary by Shao: Opening the Lung is equivalent to opening the Taiyang channel; this is the correct treatment method for "Cold Wrapping Fire."
Generally, if a person's Stomach Yang is robust, when wind-cold invades, it only circulates within the Yang channels and does not directly enter the Three Yin channels. If Stomach Yang is deficient, however, cold will invade the Taiyang channel, and the Taiyin Spleen channel will simultaneously suffer. For example, fever and aversion to cold accompanied by diarrhea illustrate this. In such cases, the tongue must be moist without thirst, and the pulse must be deep and slow. The method should be to warm the middle and dispel cold, using herbs such as Qianghuo (Notopterygii Rhizoma et Radix), Zisu (Perillae Folium), Houpo (Magnoliae Officinalis Cortex), Jiaoqu (Stellerae Radix Fermented), Guangpi (Citri Reticulatae Pericarpium), Muxiang (Aucklandiae Radix), Fuling (Poria), and Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) to disperse cold from the exterior and harmonize the Spleen and Stomach internally, leading to slight sweating, cessation of diarrhea, cooling of the body, and recovery. If the contraction is mild, presenting with alternating chills and fever with diarrhea, the treatment method remains the same. (Belongs to Shanghan/Cold Damage)
Stomach Yang serves as a barrier for the Three Yin channels. Once Yang Qi is deficient, cold pathogen can invade the Three Yin channels. However, if Kidney Qi is not deficient, the Shaoyin channel will not be affected. If Kidney Qi becomes deficient, then the Yang within Kan (the Kidney/Ministerial Fire) is insufficient to resist Yin pathogen, and the pathogen enters the Kidney from the Taiyang channel. Whenever Taiyang exterior signs are seen, along with a deep and fine pulse, aversion to cold in the shoulder and back, loose stools, and clear urine, this constitutes simultaneous disease of the Taiyang and Shaoyin channels, which is a severe condition. The method should be to warm the interior and dispel cold, using Guizhi Tang (Cinnamon Twig Decoction) added with Danggui (Angelicae Sinensis Radix - wine-fried), Shanyao (Dioscoreae Rhizoma), Ganjiang (Zingiberis Rhizoma), Duhuo (Angelicae Pubescentis Radix), Xixin (Asari Radix et Rhizoma), and Hutao (Juglandis Semen) to warm the Kidney and drive out pathogen. If the eyes roll upward (Daiyan), breathing is rapid with wheezing, or opisthotonos with spasms occurs, these are particularly critical prognoses. This is what Zhang Jingyue referred to as "Taiyang not yet resolved, Shaoyin collapsing first." Da Wenzhong Yin (Great Middle-Warming Decoction) must be used as the primary treatment, hoping to restore Yang Qi and induce sweating, thereby offering a chance for survival. (Belongs to Shanghan/Cold Damage)