背上恶寒人少会。少阴之病口中和。三阳合病口干燥。以此区分免致讹。
背恶寒者。谓身体不恶寒。独在背上也。经云。背为阳。腹为阴。背恶寒者。阳不
足也
。然有阴阳二证。若邪热陷内。消耗津液。故口中干燥。全无滋吐。宜用人参白虎汤主之。
又中暑亦有背恶寒症。但面垢自汗。脉虚而伏。亦宜服之。若脾胃素虚之人。遇暑月饮冰
水。啖生冷。寒气蓄聚。阴上乘阳。致寒从背起。冷如掌大。当以温药主之。大顺散之类是
也。
大顺散内用干姜。桂杏还同甘草良。中暑却宜专服此。井花调服自安康。
恶寒发热发于阳。阴病憎寒身体凉。解表桂枝并越婢。温中须索理中汤。
恶寒一症。即前云寒邪外束。则恶寒也。此复举以言之。分别三阳三阴之不同也。若在
三阳
、则必发热。若在三阴、则专恶寒而不发热。在三阳则宜解表。如羌活汤、解肌汤、小柴胡
汤、各随证用之。如中三阴则宜理中汤、或四逆汤、皆可选用也。如桂枝汤越婢汤未可轻用
。
汗后恶寒宜芍药。脉沉发热下尤良。四肢疼痛仍兼利。厥冷须投四逆汤。
伤寒汗后。则寒邪自散。不当恶寒。然汗后犹恶寒者。何也。盖阳微则恶寒。须芍药汤
以收
敛之。倘脉沉属里。发热恶寒者。恐内有积热。宜下之为良也。若四肢疼痛泻利厥冷。此阴
症也。宜四逆汤温之。
背上怕冷的人很少能准确辨识。少阴病的特点是口中平和湿润；三阳合病的特点是口干燥。根据这些特征进行区分，可以避免误诊。
所谓背恶寒，是指身体其他部位不怕冷，唯独背部感到寒冷。医经说：背部属阳，腹部属阴。背部恶寒，是因为阳气不足。
然而，这有阴阳两种证型。如果是邪热内陷，消耗津液，导致口中干燥，完全没有唾液分泌（或无痰涎），适宜用人参白虎汤主治。另外，中暑也会出现背恶寒的症状，但伴有面色污垢、自汗、脉象虚而沉伏，也适宜服用此方。如果是脾胃素来虚弱的人，在暑月饮用冰水、吃生冷食物，寒气积聚，阴寒之气上乘于阳位，导致寒气从背部升起，感觉像手掌大小的一块区域发冷，应当用温性药物治疗，如大顺散之类的方剂。
大顺散中含有干姜，桂枝、杏仁与甘草配合良好。中暑却适宜专门服用此方，用井花水调服，自然安康。
恶寒发热出现在阳经病变中；阴经病变则是憎寒且身体发凉。解表治疗可用桂枝汤和越婢汤；温中治疗必须选用理中汤。
恶寒这一症状，就是前面所说的寒邪外束，所以出现恶寒。这里再次列举说明，以区分三阳和三阴的不同。如果在三阳经，则必定伴有发热；如果在三阴经，则专门恶寒而不发热。在三阳经适宜解表，如羌活汤、解肌汤、小柴胡汤等，可根据具体证候选用。如果传入三阴经，则适宜使用理中汤，或者四逆汤，都可以选择使用。如桂枝汤、越婢汤不可轻易使用。
出汗后仍恶寒适宜用芍药汤；脉沉且发热，用下法更为良善。如果四肢疼痛并兼有腹泻，厥冷严重须投用四逆汤。
伤寒经过发汗治疗后，寒邪应当自行消散，不应当再出现恶寒。然而出汗后仍然恶寒，为什么呢？这是因为阳气微弱导致恶寒，需要用芍药汤来收敛阳气。倘若脉象沉伏属于里证，伴有发热恶寒，恐怕体内有积热，适宜用下法治疗为良策。如果四肢疼痛、腹泻、四肢厥冷，这是阴症，适宜用四逆汤来温补。
Few people can accurately identify back chills. Shaoyin disease is characterized by a moist and neutral mouth; San Yang combined disease is characterized by dry mouth. Distinguishing based on these features prevents misdiagnosis.
"Back chills" refers to a condition where the rest of the body does not feel cold, but only the back feels cold. The classics state: The back belongs to Yang, and the abdomen belongs to Yin. Back chills indicate insufficient Yang Qi.
However, there are two syndromes: Yin and Yang. If pathogenic heat sinks inward and consumes body fluids, causing dryness in the mouth with no saliva or phlegm, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) is indicated. Additionally, heatstroke may also present with back chills, accompanied by a greasy complexion, spontaneous sweating, and a deficient, deep pulse; this formula is also suitable. For individuals with inherent Spleen and Stomach deficiency who consume ice water or raw/cold foods during summer months, cold qi accumulates. Yin cold rises to override Yang, causing cold to rise from the back, feeling as cold as the size of a palm. Warm herbs should be used, such as Da Shun San.
Da Shun San contains Gan Jiang (Dried Ginger), Gui Zhi (Cinnamon Twig), Xing Ren (Apricot Seed), and Gan Cao (Licorice Root). It is specifically suitable for heatstroke; taken with well-water, it ensures health.
Chills and fever manifest in Yang diseases; Yin diseases manifest as aversion to cold with a cool body. To release the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) and Yue Bi Tang (Yuebi Decoction) are used; to warm the middle, Li Zhong Tang (Regulate the Middle Decoction) must be sought.
The symptom of chills refers to the previously mentioned external binding of cold pathogens. This reiterates the distinction between San Yang and San Yin. If in San Yang, fever must be present; if in San Yin, there is exclusively chills without fever. In San Yang, releasing the exterior is appropriate, using formulas such as Qiang Huo Tang, Jie Ji Tang, or Xiao Chai Hu Tang according to the syndrome. If entering San Yin, Li Zhong Tang or Si Ni Tang are selectable. Gui Zhi Tang and Yue Bi Tang should not be used lightly.
After sweating, if chills persist, Shao Yao Tang is indicated. If the pulse is deep and fever is present, purgation is superior. If accompanied by limb pain and diarrhea, and cold extremities, Si Ni Tang must be administered.
After sweating in Shang Han (Cold Damage), cold pathogens should dissipate, and chills should cease. Why do chills persist after sweating? This is due to weak Yang Qi causing chills; Shao Yao Tang should be used to consolidate. If the pulse is deep indicating an interior syndrome, accompanied by fever and chills, internal accumulated heat is suspected, and purgation is the optimal treatment. If there is limb pain, diarrhea, and cold extremities, this is a Yin syndrome, and Si Ni Tang should be used to warm.