病患身大热，反欲近衣者，热在皮肤，寒在骨髓也；病患
身大寒，反不欲近衣者，寒在皮肤，热在骨髓也。
此属内因，不是外感，亦不关于七情。病在形躯，不涉脏腑，亦不犯于经络。故无六经脉证之可凭，非天时寒
热所可拘也。是病只在骨髓，不在皮肤。皮肤寒热，是指天时，不是指病。两身字言身当其时也。若指皮肤，则
不可为骨髓非身矣。风寒之邪得之于骤，故无定体。或发热恶寒，或骨内热而脏腑寒，或手足寒而肠胃热，或内
外皆寒，或表里俱热，此骨髓之邪积渐使然，故无定体。伤寒中风之寒，是时令之邪气，故感其邪者，畏而恶
之。此大热大寒，是时令之正气，因病非外来，故反欲之。伤寒中风之发热，是人身之阳气，故能与寒气相争。此
骨髓之寒热，是渐积之伏邪，故虽逢天令之大寒大热，亦不能除。时大热而身反欲复衣，时大寒而反欲裸身，此
病在骨髓，与病营卫者不同。法当以六味、八味二丸，补肾中之真阴真阳，而骨髓之蓄热痼寒，可得渐平耳。
原化嗣伯水攻之法，但可以资谭柄，而不可为继也。
问曰∶“病有洒淅恶寒而复发热者何？”答曰∶“阴脉不足，阳往从之；阳脉不足，阴往乘之。”曰∶“何
谓阳不足？”答曰∶“假令寸口脉微，名曰阳不足，阴气上入阳中，则洒淅恶寒也。”曰∶“何谓阴不足？”答
曰∶“尺脉弱，名曰阴不足，阳气下陷入阴中，则发热也。”
前条病在骨髓，故着而不移；此病在经络，故寒热反复。然与外感之往来寒热，疟疾之鼓颔战栗又不同。病
得之外感而恶寒发热者，必见有余之脉；病得之内因而恶寒发热者，全是不足之脉。见脉之不足，则寒固为虚寒，
而热亦为虚热矣。寸者，阳所治也。寸口脉微，则微为无阳，是阳脉不足，故下焦之阴寒，得以上乘阳位，而洒
淅恶寒也。尺者，阴所治也。尺脉弱为血虚，是阴脉不足，故上焦虚阳，得以下陷阴部而发热也。人身阴阳之气，
互为之根，而又以阳为主，故阳脉微则阴脉亦弱。其始也，乘阳而恶寒，阴不平则阳不秘，故继也，从阳而发热。
夫阳为阴乘，阳脉固见其不足，而阴脉亦不见其有余。阳虽微，尚能发热，不终恶寒，犹不失阳道实阴道虚之定局
耳。亡阳则阴不独存矣，故治之者，当以扶阳为急。此补中益气之方，为功最巨也。
病患脉微而涩者，此为医所病也。大发其汗，又数大下之，其人亡血，病当恶寒，后乃发热无休止时。夏
月盛热，欲着复衣；冬月盛寒，欲裸其身。所以然者，阳微则恶寒，阴弱则发热。此医发其汗，使阳气微，又
大下之，令阴气弱。五月之时，阳气在表，胃中虚冷。以阳气内微，不能胜冷，故欲着复衣。十一月之时，阳气
在里，胃中烦热。以阴气内弱，不能胜热，故欲裸其身。又阴脉迟涩，故知亡血也。
先寒后热，阳微阴弱，具证与上文同。前条病因在血脉虚，此病因在妄汗下，以致亡血而脉微涩也。夏月
四句，是写寒热发作时状。始而恶寒，虽在盛夏，欲着复衣；继而发热，虽当隆冬，欲裸其身。此是设辞，勿
以无休止时，作绵连冬夏解也。医发其汗以下，又重释前义，亦蛇足矣。
此条又可分作四证者∶寒热往来不休如疟者，为一证；或阳气内微，但恶寒不发热，病在盛暑而欲着复衣
者，为一证；或阴气内弱，但发热不恶寒，病在隆冬而欲裸身者，为一证；或其人绵连冬夏，在盛暑反恶寒，
隆冬反恶热为一证。此各从元气之浓薄，而寒热为之浅深耳。
患者身体感觉非常发热，反而想要靠近衣物取暖的，是热邪在体表（皮肤），寒邪在体内深层（骨髓）；患者身体感觉非常寒冷，反而不想靠近衣物的，是寒邪在体表（皮肤），热邪在体内深层（骨髓）。
这属于内因致病，不是外感邪气所致，也与七情（喜、怒、忧、思、悲、恐、惊）无关。病位在形体躯壳，不涉及脏腑，也不侵犯经络。因此没有六经（太阳、阳明、少阳、太阴、少阴、厥阴）脉证可以依据，不受天时气候寒热的限制。这种病只在骨髓，不在皮肤。文中所说的“皮肤”和“骨髓”的寒热，是指天时的寒热，而不是指病位。两个“身”字，是说身体处于当时的时令环境中。如果是指病位，那么就不能说骨髓不是身体的一部分了。风寒之邪如果是突然感受到的，所以没有固定的形态。有的表现为发热恶寒，有的表现为骨内热而脏腑寒，有的表现为手足寒而肠胃热，有的表现为内外皆寒，有的表现为表里俱热。这是骨髓中的邪气逐渐积累而成的，所以没有固定的形态。伤寒和中风所感受的寒邪，是时令的邪气，所以感受了这种邪气的人，会畏惧并厌恶它。而这种大热大寒，是时令的正气，因为病不是从外部来的，所以反而想要它。伤寒和中风的发热，是人体自身的阳气，所以能与寒气相争。而这种骨髓中的寒热，是逐渐积累的伏邪，所以即使遇到时令的大寒大热，也不能消除。时令大热时身体反而想多穿衣服，时令大寒时身体反而想脱掉衣服，这是因为病在骨髓，与病在营卫（营气和卫气）的不同。治疗方法应当使用六味丸（六味地黄丸）、八味丸（金匮肾气丸）这两类丸药，来补肾中的真阴和真阳，这样骨髓中蓄积的热邪和顽固的寒邪，才可以逐渐平复。至于原化嗣伯用水攻的方法，只能作为谈资，不可以作为继承遵循的方法。
问：“有病像被水洒湿一样感到寒冷，随后又发热的，是什么原因？”答：“阴脉不足，阳气就会去依附它；阳脉不足，阴气就会去乘袭它。”问：“什么叫阳不足？”答：“假如寸口脉微，叫做阳不足，阴气向上进入阳分，就会像被水洒湿一样感到寒冷。”问：“什么叫阴不足？”答：“尺脉弱，叫做阴不足，阳气向下陷入阴分，就会发热。”
前一条的病在骨髓，所以症状固定不移；这一条的病在经络，所以寒热反复交替。然而这与外感引起的往来寒热、疟疾引起的咬牙战栗又不同。病由外感引起而出现恶寒发热的，必定见到有余的脉象；病由内因引起而出现恶寒发热的，全是不足的脉象。看到脉象不足，那么寒固然是虚寒，热也是虚热了。寸部，是阳气所主管的部位。寸口脉微，说明微就是无阳，是阳脉不足，所以下焦的阴寒之气，得以向上侵犯阳位，从而出现像被水洒湿一样的恶寒。尺部，是阴气所主管的部位。尺脉弱表示血虚，是阴脉不足，所以上焦的虚阳，得以向下陷入阴部，从而出现发热。人体的阴阳之气，互为根本，又以阳气为主导，所以阳脉微则阴脉也会弱。起初，阴气乘袭阳气而感到恶寒，阴气不平则阳气不能固秘，所以接着，阳气随阴气而从阳分导致发热。既然阳气被阴气乘袭，阳脉固然表现出不足，而阴脉也不会表现出有余。阳气虽然微弱，尚能发热，不会始终恶寒，仍然符合阳道实、阴道虚的定局。如果亡阳，那么阴气就不能单独存在了，所以治疗的人，应当以扶助阳气为急务。补中益气汤这个方剂，功效最为巨大。
患者脉象微而涩的，这是医生治疗失误造成的。大发其汗，又多次峻下，导致其人亡血（失血或血液亏虚），病人应当恶寒，后来才发热且没有停止的时候。夏季天气极热，却想穿厚衣服；冬季天气极寒，却想脱光身体。之所以这样，是因为阳气微弱则恶寒，阴气虚弱则发热。这是医生发了汗，使阳气微弱，又大下，令阴气虚弱。五月的时候，阳气在体表，胃中虚冷。因为阳气内部微弱，不能战胜寒冷，所以想穿厚衣服。十一月的时候，阳气在体内，胃中烦热。因为阴气内部虚弱，不能战胜热邪，所以想脱光身体。又因为阴脉迟涩，所以知道是亡血。
先寒后热，阳微阴弱，具备的症状与上文相同。前一条病因在于血脉虚，这条病因在于妄用汗法和下法，以致亡血而脉象微涩。关于夏季的四句话，是描写寒热发作时的状态。开始恶寒，即使在盛夏，也想穿厚衣服；接着发热，即使在隆冬，也想脱光身体。这是假设性的言辞，不要将“没有停止的时候”，理解为连绵不断的冬夏季节。医生发汗和下法之后，又重新解释前面的意思，也是多余的。
这一条又可以分为四种证候：寒热往来不停止像疟疾一样的，是一种证候；或者阳气内部微弱，只恶寒不发热，病在盛暑时节却想穿厚衣服的，是一种证候；或者阴气内部虚弱，只发热不恶寒，病在隆冬时节却想脱光身体的，是一种证候；或者其人连绵经历冬夏，在盛暑反而恶寒，在隆冬反而恶热的，是一种证候。这都是根据元气浓度的厚薄，而寒热表现出的深浅不同罢了。
The patient feels intense heat in the body but desires to keep clothing on; this indicates that heat is at the skin level (superficial) while cold is at the bone marrow level (deep). The patient feels intense cold in the body but does not desire to keep clothing on; this indicates that cold is at the skin level (superficial) while heat is at the bone marrow level (deep).
These conditions belong to internal causes, not external contraction, nor are they related to the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). The disease resides in the physical form and trunk, not involving the Zang-Fu organs, nor invading the meridians. Therefore, there are no Six Meridian (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) pulse and syndrome patterns to rely upon, and it is not constrained by the seasonal climate's cold or heat. This disease lies only in the bone marrow, not in the skin. The terms "skin" and "bone marrow" regarding cold and heat here refer to the seasonal climate, not the disease location. The two uses of the character "body" (Shen) refer to the body being subject to the current season. If referring to disease location, one could not say that the bone marrow is not part of the body. Wind-Cold pathogens acquired suddenly have no fixed form. Some present with fever and aversion to cold, some with heat inside the bones and cold in the Zang-Fu, some with cold hands and feet but heat in the intestines and stomach, some with cold inside and out, and some with heat in both exterior and interior. This is caused by the gradual accumulation of pathogens in the bone marrow, hence having no fixed form. The cold from Cold Damage (Shanghan) and Wind Strike (Zhongfeng) is the pathogenic qi of the season; thus, those who contract it fear and dislike it. However, this extreme heat and cold are the righteous qi of the season. Since the disease is not exogenous, the patient actually desires it. The fever from Cold Damage and Wind Strike is the body's own Yang Qi, which can contend with Cold Qi. But the cold and heat in the bone marrow are gradually accumulated latent pathogens; thus, even when encountering the season's extreme cold or heat, they cannot be eliminated. When the season is extremely hot, the body desires extra clothing; when the season is extremely cold, the body desires to be naked. This is because the disease is in the bone marrow, differing from diseases affecting Ying and Wei (Nutritive and Defensive Qi). The treatment method should employ Liuwei Wan (Six-Ingredient Rehmannia Pill) and Bawei Wan (Eight-Ingredient Aconite Pill) to tonify the True Yin and True Yang in the Kidney, so that the accumulated heat and stubborn cold in the bone marrow may gradually subside. The water-attack method attributed to Yuan Hua and Si Bo can only serve as a topic for discussion and should not be followed.
Q: "Why does a patient experience shivering aversion to cold followed by fever?" A: "When the Yin pulse is deficient, Yang moves to follow it; when the Yang pulse is deficient, Yin moves to invade it." Q: "What is meant by Yang deficiency?" A: "If the Cun (inch) position of the pulse is faint, it is called Yang deficiency. When Yin Qi ascends into the Yang region, it causes shivering aversion to cold." Q: "What is meant by Yin deficiency?" A: "If the Chi (cubit) position of the pulse is weak, it is called Yin deficiency. When Yang Qi sinks down into the Yin region, it causes fever."
The previous condition was in the bone marrow, so the symptoms were fixed and immobile; this condition is in the meridians, so the cold and heat alternate repeatedly. However, this differs from the alternating cold and heat caused by external contraction, and from the chattering teeth and trembling seen in Malaria (Nüe Ji). Diseases causing aversion to cold and fever due to external contraction must present with excess pulses; diseases causing aversion to cold and fever due to internal causes present entirely with deficient pulses. Seeing deficient pulses means that the cold is indeed Deficient Cold, and the heat is also Deficient Heat. The Cun position is governed by Yang. A faint Cun pulse indicates a lack of Yang, meaning the Yang pulse is deficient; thus, the Yin-Cold from the Lower Jiao ascends to invade the Yang position, causing shivering aversion to cold. The Chi position is governed by Yin. A weak Chi pulse indicates Blood deficiency, meaning the Yin pulse is deficient; thus, the Empty-Yang from the Upper Jiao sinks into the Yin region, causing fever. The Yin and Yang Qi of the human body are mutually rooted, yet Yang is primary. Therefore, if the Yang pulse is faint, the Yin pulse will also be weak. Initially, Yin invades Yang causing aversion to cold; when Yin is unbalanced, Yang cannot be secured, leading subsequently to Yang following Yin and causing fever. Since Yang is invaded by Yin, the Yang pulse shows deficiency, and the Yin pulse does not show excess. Although Yang is faint, it can still generate heat and will not remain solely in aversion to cold, still adhering to the principle that Yang paths are solid and Yin paths are empty. If Yang collapses, Yin cannot exist alone; therefore, treatment must urgently support Yang. The formula Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) has the greatest efficacy in this regard.
If the patient's pulse is faint and choppy, this is iatrogenic injury. Profuse sweating followed by repeated purgation leads to loss of Blood (Wang Xue). The patient should experience aversion to cold, followed by continuous fever without cessation. In the height of summer heat, the patient desires thick clothing; in the depth of winter cold, the patient desires to be naked. The reason is that faint Yang causes aversion to cold, and weak Yin causes fever. The doctor induced sweating, making Yang faint, and performed severe purgation, making Yin weak. In the fifth month, Yang Qi is at the exterior, and the Stomach is cold and deficient. Because internal Yang is faint and cannot overcome the cold, the patient desires thick clothing. In the eleventh month, Yang Qi is in the interior, and the Stomach is vexed and hot. Because internal Yin is weak and cannot overcome the heat, the patient desires to be naked. Furthermore, the slow and choppy Yin pulse confirms the loss of Blood.
Chills preceding fever, with faint Yang and weak Yin, presents symptoms identical to the above. The previous case's cause was deficiency in the blood vessels; this case's cause was reckless use of sweating and purging methods, resulting in blood loss and a faint-choppy pulse. The four sentences about summer describe the state during the onset of cold and heat. Initially, there is aversion to cold; even in midsummer, the patient desires thick clothing. Subsequently, there is fever; even in deep winter, the patient desires to be naked. This is a hypothetical scenario; do not interpret "continuous without cessation" as spanning across winter and summer seasons. After discussing the doctor's erroneous sweating and purging, re-explaining the previous point is superfluous.
This clause can be divided into four syndromes: 1. Alternating cold and heat incessantly like malaria is one syndrome. 2. Internal Yang deficiency, presenting only with aversion to cold without fever, desiring thick clothing despite peak summer heat, is another syndrome. 3. Internal Yin weakness, presenting only with fever without aversion to cold, desiring to be naked despite deep winter cold, is another syndrome. 4. Experiencing these states continuously through winter and summer, feeling cold in peak summer and hot in deep winter, is another syndrome. These variations depend on the thickness or thinness of the Original Qi (Yuan Qi), determining the depth of the cold and heat manifestations.