伤寒恶寒，无汗而手足微冷；
霜降后，春分前，人有冲斥道途，履霜踢冰，冒犯寒气，即发为病，名曰伤寒。必先恶寒，头痛甚，鼻无
涕，其声前轻后重，口中和。虽不食亦不恶食，手足不热。病深重者，必身痛发热，冬月，麻黄汤；轻浅者，
陶氏麻黄汤；虚者，人参顺气散；三时，羌活冲和汤、小柴胡汤；通用，麻黄杏仁饮。此专辨无汗为伤寒，
盖风、暑、湿皆有汗，惟寒泣血无汗。至于初证、传变、杂证，俱详后段。
伤风恶风，自汗而手足微烦。
伤风初证，惟头疼、口和、不恶食与伤寒同。缘寒乃阴邪，风乃阳邪，所以伤寒郁而后能发热，伤风即
能发热；伤寒手足微厥，伤风手足背皆热；伤寒鼻无涕，伤风鼻流涕，其声如自瓮中出；伤寒面惨身痛，伤风
面光身重；伤寒无汗恶寒不恶风，伤风有汗恶风不恶寒，甚者自汗出不止，洒洒恶风，复啬啬恶寒。冬月，桂枝
汤；自汗小便数者，芍药甘草汤；自汗小便利脚蜷急者，桂枝汤加参、附；轻者，柴胡桂枝汤；自汗渴而小便
难者，邪渐传里，五苓散；自汗不渴者，邪在表，茯苓桂甘汤；三时，防风冲和汤、柴胡桂枝汤，或败毒散去茯
苓；鼻塞，通关散；通用，柴胡半夏汤。古立六经伤风方，见后桂枝汤下。但三阴药皆辛热，似非伤寒家法，
仲景治伤寒、伤风表证，分有汗、无汗，里证同于和解、通利，更无分别，今详桂附八物。恐亦风邪直伤阴分，
其人素虚，或房室后伤风则可，若概作表药，误人多矣。盖伤风发表，辛热不如辛温，辛温不如辛凉也。或疑
六淫，仲景独详于风寒而略于暑湿，且不及燥火，何也？盖暑火同气，燥湿同源，风寒传变六经，暑湿性偏，
着人五脏，壮者气行则已，怯者乃着为病故耳。前所谓啬啬，不足也；洒洒，洒淅也，皆恶风之貌。
治表里急，治里表急，阴同于阳为两感；
两感者，半入于阳，半入于阴，阴阳两感，脏腑俱病。一日太阳与少阴俱病，头疼，为太阳邪盛于表；
口干而渴，为少阴邪盛于里。二日阳明与太阴俱病，身热谵语，为阳明邪盛于表；不欲食腹满，为太阴邪盛于
里。三日少阳与厥阴俱病，耳聋为少阳邪盛于表；囊缩而厥，为厥阴邪盛于里也。五脏六腑俱病，欲治表而里
急，欲治里而表急，必死之证。但禀气实而感邪浅者，或挟异气、风温、风湿之类，犹可救疗，所以仲景有治
有先后，发表攻里之说。法当审其表里缓急虚实何如？如表里俱急者，大羌活汤主之。如阳证阳经先受病，身
体痛而不下利者，为表急，先以葛根、麻黄发表，后以调胃承气攻里。如阴证阴经先受病，身体痛而下利不止
者，为里急，先用四逆救里，后以桂枝救表。阴阳未分者，陶氏冲和汤探之。古法，一日太阳少阴，五苓散主
之，头痛加羌活、防风；口渴加黄柏、知母。二日阳明太阴，大柴胡汤。三日少阳厥阴，危甚，大承气汤
加川芎、柴胡救之。《活人》不分阴阳，专用
四逆、桂枝，先辈皆以为谬。大抵两感，脉从阳可治，从阴难治。
伤风见寒，伤寒见风，脉不合证而相反。
先伤寒而后伤风者，证伤寒也，而见伤风之脉；先伤风而后伤寒者，证伤风也，而见伤寒之脉。此乃荣卫
俱实，故无汗而烦躁，大青龙汤。不烦躁者，桂麻各半汤。通用，大羌活汤，九味羌活汤加人参、大枣，或神
术散、香苏散。
三阳合病，自利而汗下，审在经入腑；
或一阳先病，一阳随病，或二阳同病，或三阳同病，不传者谓之合病。自利者，下利溏泄。三阳合病，寒
邪甚而里气不和也。气行下则利，气逆上则呕。太阳合阳明自利，恶寒者，升麻葛根汤；恶热者，白虎汤。
太阳合少阳自利者，黄芩汤；呕者，并加半夏、生姜。阳明合少阳自利最重，小柴胡合升麻葛根汤。有宜下者，
本太阳病，因汗下渗亡津液，胃腑燥实，转属阳明，谓之太阳阳明，脾约丸润之。本少阳病，因汗渗，热入胃
腑，大便燥者，大柴胡微下之。本阳明经病，热盛传入胃腑，谓之正阳阳明，乃本经自病也，宜调胃承气汤
从中治之。盖太阳少气，少阳少血，惟阳明居二阳之中，气血俱多，所以从中治阳明，而不敢犯太阳、少阳也，
又三阳合病，面垢，腹胀满，身重难转侧，谵语遗溺，口燥不仁，大便难者，白虎加参汤主之，不可汗下，
亦中治法也。有宜汗者，表证头疼、恶寒未除，为太阳尚未过经，尤宜发汗。如太阳阳明，喘而胸满者，麻
黄汤。太阳少阳，麻黄汤合小柴胡汤。通用，九味羌活汤加石膏、知母、枳壳。盖在经则汗，过经宜下也。
三阳并病，可汗而攻通，必传胃归根。
并者，催并逼迫之意。始初二阳合病，后一阳气盛，一阳气衰，并归一经独重，初证亦不解罢。阳明并
太阳者，太阳证未解，阳明证又至，麻黄汤合升麻葛根汤。如太阳证重，加太阳经药；阳明证重，加阳明经药，
后仿此。少阳并太阳者，太阳证未解，少阳证又至，麻黄汤合小柴胡汤。头痛项强，眩冒如结胸状者亦宜。通
用，九味羌活汤。少阳并阳明者，为木克土，难治，小柴胡汤合升麻葛根汤、柴胡升麻汤救之。是并病，在表
者皆可汗。若太阳证罢，乃入胃腑者，谓之传经，非并也，宜量体攻下。旧云∶三阴无合、并二病。然三阴
亦有自相合并者，但非两感，必无阴经与阳经合并之理。
但闻疫疠能传染，
疫，疾如有鬼疠相似，故曰疫疠，又曰时气。春应暖而反清，夏应热而反凉，秋应凉而反大热，冬应寒
而反大温，非其时而有其气。凡感之者，即发头疼身痛寒热，一方长幼病皆相似。治与伤寒微异者，春清责肝，
升麻葛根汤；夏热责心，二香散、调中汤；秋湿责肺，白虎加苍汤、茵陈五苓散；冬寒责肾，葳蕤汤、甘桔
汤；土旺四季，随经取之。治与伤寒同者，表证，败毒散；半表里，小柴胡汤；里证，大柴胡汤；挟内伤者，
宜补、宜散、宜降，人中黄丸是也。经曰∶疫气不拘于诊，更当于运气求之。凡人疫家，用麻油服之，或纸捻
蘸麻油并雄黄、朱砂末，探入耳鼻内，最能避秽毒之气，遍满乡村，善用如意丹亦妙。
岂知正气亦多愆。
经曰∶春气温和，夏气暑热，秋气清凉，冬气冷冽。以伤寒为毒者，以其最成杀厉之气也。其有伤于四
气，留在何经而发何病？大概春伤于风，夏必飧泄；夏伤于暑，秋必疟痢；秋伤于湿，冬必咳嗽；冬伤于寒，
春必 疟。 者，二日一发；疟者，一日一发。秋伤于湿不即发者，及冬风寒相搏，痰涎生而为咳嗽。冬伤
于寒不即发者，及春温气相搏，变为温病。是四时正气，亦能愆和如此。皆因发动之时，逆推致病之源，非
受伤之时，预拟今日之病，故有久而消散不成病者，岂可执一论哉！但稍觉气淫于内，心腹不快者，不换金正
气散加减，以正胃气。
春变为温，夏变为热。
温病者，春分后有太阳病，发热、咳嗽、身痛、口渴、不恶寒、其脉弦数不紧，右手反盛于左手，盖怫热
在内故也，或散在诸经，各取其经而治之。热病即与温病同，但发在夏至后，脉洪数，热渴更甚耳。虽因冬时
受寒，伏于肌骨，然人身随天气化，春分则寒变为温，夏至则寒变为热。所以，伤寒恶寒而不渴，温热不恶寒
而渴。不恶寒则病非外来，渴则自内达表，热郁腠理，不得外泄，乃复还里，终是里多表少。间有恶寒者，
乃冒非时暴寒，或温暑将发，又受暴寒，非冬证之甚也。法当治里热为主，而解肌次之，亦有专治里而表自解
者。误下犹可，误汗则变为呕、哕、狂、斑而死。盖温热在经而不在表，安可例用伤寒汗法！惟兼暴寒者，乃
可表里双解，亦不敢用冬月辛温之药。春温表证，天温，升麻葛根汤；天寒，柴胡桂枝汤。太阳合少阳，败毒
散合小柴胡；太阳合阳明，败毒散合升麻葛根；阳明合少阳，升麻葛根汤合小柴胡汤。半表里，小柴胡。里证，
大柴胡。重者，一时表里俱发，防风通圣散。表里俱热，大便自利者，柴苓汤加山栀、木通。虚烦，竹叶石
膏汤。变杂证，悉同伤寒。夏热表证，太阳，九味羌活汤；汗后烦渴，脉洪大，背恶寒者，白虎加参汤、益元
散。里证，大柴胡。重者，一时表里盛发，双解散。热病脉细无力，足冷，已得汗而躁盛者，此阴脉之极也，
必死。详温暑门。
晚发疑为秋病，质诸高明；
先辈云∶清明至夏至前，太阳病者，谓之晚发，比之温病稍轻。盖以感之轻者发之早，感之重者发之迟。
从立秋至霜降，有患太阳证者，亦名温病，治法同温热，但加燥剂于解肌药中，里证一同伤寒。但既以三月
至夏至为晚发，春分前又为正伤寒，不知春温在于何月，更考三月至夏至前，名为春温，则晚发当属于秋矣。
立秋前后病者，因湿热而发；处暑后病者，因燥热而发，庶乎四时六气，备而不混，而治之各随其时耳。
大概表证，九味羌活汤、栀子升麻汤；里证，大柴胡汤加生地，或导滞通幽汤。变杂证者，随宜施治。
冬温总是时行，加乎调燮。
冬有非时之暖，名曰冬温。与春秋暴寒、暴温总谓之时行气，与伤寒相似，但脉不浮耳。治法大同春温。
表证，葳蕤汤、九味羌活汤，入里加大黄，重者双解散，轻者加减调中汤。
静而得之为中暑，动而得之为中 。
暑、 皆自汗烦渴，脉虚，面垢昏倦。静而热伤心脾为中暑，与夏热病相似，但热病脉洪紧，中暑脉细数
而沉。动而热伤太阳为中 ，脉浮似夏伤风。但汗出恶风，身热而不渴者，伤风也。汗出恶寒身热而渴者，
中也。加之身痛且重者，必夏月伤冷，或澡浴水行皮中所致。中 心腹疼痛，霍乱吐泻转筋，甚则发厥昏闷，
香薷散；痰逆恶心恶寒者，橘皮竹茹汤；汗多渴而不恶寒者，竹叶石膏汤；暑湿相搏，身痛心痛烦渴恶心尿赤
者，五苓散；湿盛胸满者，瓜蒂散吐之；若小便已，洒然毛耸，口开前版齿燥黑，肢厥，小劳身即热者，表里
俱病也，白虎加参汤；有湿者，白虎加苍汤和之。切忌汗下针灸，汗则恶寒，下则内虚变淋，灸则助火发热。
中暑发热烦躁口渴者，小柴胡汤加香薷；泻利口渴者，香薷散合四苓散；元气素弱，脉虚身倦者，清暑益气汤；
昏愦不苏者。葱饼熨脐。
暴寒寒疫，与伏藏已变之寒，自是情违；
春分至秋分，暴寒曰寒疫，非冬月伤寒比也。三月四月，或有暴寒，阳气尚弱，为寒所折，病热犹轻。五月
六月，阳气已盛，为寒所折，病热则重。七月八月，阳气已衰，为寒所折，病热亦微。伤之者，其病与温暑相
似。而治则殊者，盖温暑伏寒自内而发，寒疫自外而入，宜调中汤为主，随时气候寒热轻重而以辛凉、辛温之
药加减。盖折者，折抑阳气，郁而为
热也。感之轻而阳气不为所折，未至发热者，当于感冒药中求之。
暴温温疫，与过经不除之温，皆难汗发。
春三四月间，暴热伤之者，亦名温病。伤寒汗下过经不解者，亦名温病。但当随各经见证治之，皆不宜汗
下。暴温，栀子升麻汤、九味羌活汤。过经，和解散、参胡芍药汤。
风温喘渴多睡，四肢不收若瘫；
太阳病，发汗则身凉。如发汗身犹灼热者，乃风温也。当春温气大行，又感风邪所致。惟风伤卫，四肢
缓纵不收若瘫痪然；惟温伤气，气昏而鼻息不利，语言謇涩，身热自汗多眠。治在心火肝木二经，忌汗、下、
针。误汗则身必灼热，甚则烦渴谵黄；下则遗溺；针则耳聋。惟清解肌表为佳，宜葳蕤汤、败毒散，或小柴胡
加桂枝微汗之。渴甚者，栝蒌根汤。痰喘者，金沸草散加杏仁、细辛、五味子。误汗，防己黄 汤救之。谵语
独语及直视遗尿者难治。
湿温胸满妄言，两胫逆冷如雪；
夏月先伤湿，而后伤暑，名曰湿温。湿与热搏，两胫逆冷，甚则遍身亦冷，胸满头痛，壮热自汗。若再
发汗，令人呕聋，身变青色，不语，名曰重 ，必死。治在心火脾土，茯苓白术汤，湿胜溺涩便利者，五苓散、
除湿汤。脏滑者，术附汤。暑胜壮热二便涩者，香薷散、六和汤。便闭渴谵，白虎加苍汤。
风湿，头汗身重而大便难；
先伤湿而后伤风，风先上受，湿先下受，风湿相搏，风在外而湿在内。大汗则其气暴而内邪不能出，故
风去而湿存，湿流入里则病重。微汗则其气缓而内外之邪俱去，或湿证去而风证未去者，不久自解。寒热身痛，
麻杏薏甘汤；体痛发热，小便不利，麻黄汤加苍术；肩背脊腰强痛者，羌活胜湿汤；肿痛微喘，杏仁汤；汗多，
汉防己汤；虚者，身重难以转侧，桂枝汤加白术；身重昏迷，自汗失音，下利不禁者，白通汤加白术、甘草；
身痛小便不利者，甘草附子汤；身重走痛者，小续命汤去麻黄、附子；热而重痛烦渴者，败毒散去柴胡、人参，
加栝蒌根。小便自利及下利不止者，死。
寒湿，头汗身痛而大便泄。
伤寒无汗，寒湿相搏而有汗，不能周身，惟在头耳。身背强者，表不利也，证与风湿相似，渗湿汤主之；
伤寒表现为恶寒，无汗且手足轻微发冷；
在霜降之后、春分之前，有人奔波于道路之上，踩踏霜雪冰凌，冒犯寒气，随即发病，这种病称为伤寒。必定先出现恶寒，头痛剧烈，鼻中无鼻涕，声音前轻后重，口中味觉正常。虽然不想吃东西，但也不厌恶食物的气味，手足不发热。病情深重的，必然身体疼痛并伴有发热，冬季用麻黄汤；病情轻浅的，用陶氏麻黄汤；体质虚弱的，用人参顺气散；春夏秋三季，用羌活冲和汤或小柴胡汤；通用方剂为麻黄杏仁饮。这是专门辨析无汗属于伤寒，因为风、暑、湿都有汗，只有寒邪使血液凝涩而无汗。至于初起证候、传变过程及杂证，都在后面的段落中详细说明。
伤风表现为恶风，自汗且手足轻微烦热。
伤风的初起证候，只有头痛、口中味觉正常、不厌恶食物与伤寒相同。因为寒是阴邪，风是阳邪，所以伤寒郁结后才能发热，伤风则立即能发热；伤寒手足轻微厥冷，伤风手足背部都发热；伤寒鼻中无鼻涕，伤风鼻流鼻涕，声音像从瓮中发出一样沉闷；伤寒面色惨淡身体疼痛，伤风面色光亮身体沉重；伤寒无汗恶寒但不恶风，伤风有汗恶风但不恶寒，严重的自汗不止，洒洒然怕风，又啬啬然怕冷。冬季用桂枝汤；自汗且小便频数的，用芍药甘草汤；自汗且小便通利、脚部蜷缩拘急的，用桂枝汤加人参、附子；轻症的，用柴胡桂枝汤；自汗口渴且小便困难的，说明邪气逐渐传入里，用五苓散；自汗不口渴的，说明邪气仍在表，用茯苓桂甘汤；春夏秋三季，用防风冲和汤或柴胡桂枝汤，或者败毒散去茯苓；鼻塞的，用通关散；通用方剂为柴胡半夏汤。古人制定了六经伤风的方剂，见后面桂枝汤条下。只是三阴经的药都是辛热的，似乎不符合伤寒家的法度，张仲景治疗伤寒、伤风的表证，区分有汗和无汗，里证同于和解、通利，更没有分别，现在详细论述桂枝、附子等八物汤。恐怕也是风邪直接伤害阴分，其人本来虚弱，或者房事后伤风才可以，如果一概作为表证用药，误人太多了。大概伤风发表，辛热不如辛温，辛温不如辛凉。有人怀疑六淫邪气，张仲景唯独详细论述风寒而略于暑湿，并且不及燥火，为什么呢？大概暑火同气，燥湿同源，风寒传变涉及六经，暑湿性质偏颇，附着于五脏，强壮的人气机运行则病愈，体弱的人才附着成为疾病罢了。前面所说的“啬啬”，是不足的样子；“洒洒”，是洒淅的样子，都是怕风的情状。
治疗表里俱急，治疗里表俱急，阴经与阳经同时受邪称为两感；
两感病，一半进入阳经，一半进入阴经，阴阳两经同时受邪，脏腑都生病。第一天太阳经与少阴经同时生病，头疼，是因为太阳邪气盛于表；口干而渴，是因为少阴邪气盛于里。第二天阳明经与太阴经同时生病，身热谵语，是因为阳明邪气盛于表；不想吃饭腹部胀满，是因为太阴邪气盛于里。第三天少阳经与厥阴经同时生病，耳聋是因为少阳邪气盛于表；阴囊收缩且四肢厥冷，是因为厥阴邪气盛于里。五脏六腑都生病，想治表证而里证紧急，想治里证而表证紧急，是必死的证候。但是禀赋之气充实且感受邪气浅的，或者夹杂异气、风温、风湿之类，还可以救治，所以张仲景有治疗的先后顺序，发表攻里的说法。治法应当审察其表里缓急虚实如何？如果表里都紧急，用大羌活汤主治。如果是阳证阳经先受病，身体疼痛而没有下利的，是表证紧急，先用葛根、麻黄发散表邪，后用调胃承气汤攻逐里实。如果是阴证阴经先受病，身体疼痛且下利不止的，是里证紧急，先用四逆汤救里，后用桂枝汤解表。阴阳未分的，用陶氏冲和汤试探。古法，第一天太阳少阴同病，用五苓散主治，头痛加羌活、防风；口渴加黄柏、知母。第二天阳明太阴同病，用大柴胡汤。第三天少阳厥阴同病，危重，用大承气汤加川芎、柴胡救治。《活人书》不分阴阳，专用四逆、桂枝汤，前辈们都认为这是错误的。大概两感病，脉象从阳可治，从阴难治。
伤风见到伤寒的脉象，伤寒见到伤风的脉象，脉象与证候不合而相反。
先患伤寒而后伤风的，证候是伤寒，却见到伤风的脉象；先伤风而后伤寒的，证候是伤风，却见到伤寒的脉象。这是因为营卫都实盛，所以无汗且烦躁，用大青龙汤。不烦躁的，用桂麻各半汤。通用方剂为大羌活汤，九味羌活汤加人参、大枣，或者神术散、香苏散。
三阳合病，自下利且经过汗下治疗后，需审察是在经还是在腑；
或者一阳经先病，另一阳经随后发病，或者两阳经同病，或者三阳经同病，不传变的叫做合病。自下利，指下利稀溏。三阳合病，是寒邪严重且里气不和。气行向下则下利，气逆向上则呕吐。太阳合阳明自下利，恶寒的，用升麻葛根汤；恶热的，用白虎汤。
太阳合少阳自下利的，用黄芩汤；呕吐的，再加半夏、生姜。
阳明合少阳自下利最重，用小柴胡汤合升麻葛根汤。
有宜用下法的，原本太阳病，因为发汗、攻下导致津液耗损，胃腑干燥结实，转属阳明，称为太阳阳明，用脾约丸润下。原本少阳病，因为发汗渗泄，热入胃腑，大便干燥的，用大柴胡汤微下之。原本阳明经病，热盛传入胃腑，称为正阳阳明，是本经自病，宜用调胃承气汤从中焦治疗。大概太阳经少气，少阳经少血，只有阳明经居于二阳之中，气血都多，所以从中焦治疗阳明，而不敢侵犯太阳、少阳。另外三阳合病，面部污垢，腹胀满，身体沉重难以翻身，谵语遗尿，口燥麻木，大便困难的，用白虎加人参汤主治，不可发汗攻下，这也是从中焦治疗的法则。有宜用汗法的，表证头痛、恶寒未除，说明太阳经病尚未过经，尤其适宜发汗。如太阳阳明合病，喘且胸满的，用麻黄汤。太阳少阳合病，用麻黄汤合小柴胡汤。通用方剂为九味羌活汤加石膏、知母、枳壳。大概病在经可用汗法，过经宜用下法。
三阳并病，可发汗而攻通，必定传胃归根。
并，有催并逼迫的意思。开始是初二阳合病，后来一阳经气盛，一阳经气衰，并归一经独重，初起证候也不解除。阳明并太阳者，太阳证未解，阳明证又至，用麻黄汤合升麻葛根汤。如果太阳证重，加太阳经药；阳明证重，加阳明经药，后面仿照此例。少阳并太阳者，太阳证未解，少阳证又至，用麻黄汤合小柴胡汤。头痛项强，眩晕昏蒙像结胸状的也适宜。通用方剂为九味羌活汤。少阳并阳明者，为木克土，难治，用小柴胡汤合升麻葛根汤、柴胡升麻汤救治。这种并病，在表的都可以发汗。如果太阳证罢去，才进入胃腑的，称为传经，不是并病，宜根据体质攻下。旧说：三阴经没有合病、并病两种情况。然而三阴经也有自相合并的，只是不是两感，必定没有阴经与阳经合并的道理。
只听说疫疠能传染，
疫，疾病如有鬼疠相似，所以叫疫疠，又叫时气。春天应暖反清，夏天应热反凉，秋天应凉反大热，冬天应寒反大温，非其时而有其气。凡是感染的，立即发作头疼身痛寒热，一个地方老少得的病都相似。治疗与伤寒略有不同的，春季清责肝，用升麻葛根汤；夏季热责心，用二香散、调中汤；秋季湿责肺，用白虎加苍术汤、茵陈五苓散；冬季寒责肾，用葳蕤汤、甘桔汤；土旺于四季，随经取穴治疗。治疗与伤寒相同的，表证用败毒散；半表里用小柴胡汤；里证用大柴胡汤；挟带内伤的，宜补、宜散、宜降，人中黄丸就是这类。经文说：疫气不拘泥于诊脉，更应当从运气方面求索。凡是患疫病的人家，服用麻油，或者用纸捻蘸麻油并雄黄、朱砂末，探入耳鼻内，最能避开秽毒之气，遍满乡村，善用如意丹也很好。
哪里知道正气也多有过失。
经文说：春气温和，夏气暑热，秋气清凉，冬气冷冽。把伤寒看作毒邪，因为它是最成杀厉之气。如果有被四气所伤，留在哪条经而发什么病？大概春天伤于风，夏天必定飧泄；夏天伤于暑，秋天必定疟痢；秋天伤于湿，冬天必定咳嗽；冬天伤于寒，春天必定疟疾。瘅（dàn）者，两天发作一次；疟者，一天发作一次。秋天伤于湿如果不立即发作，等到冬天风寒相搏，痰涎产生而成为咳嗽。冬天伤于寒如果不立即发作，等到春天温气相搏，变为温病。这四时正气，也能失调到如此程度。都是因为发动之时，逆推致病的源头，不是在受伤之时，预先拟定今天的病，所以有的久而消散不成病，怎么能固执一端而论呢！只要稍微觉得气淫于内，心腹不快，用不换金正气散加减，以调和胃气。
春天变为温病，夏天变为热病。
温病，是春分后有太阳病，发热、咳嗽、身痛、口渴、不恶寒，脉弦数而不紧，右手脉反而盛于左手，这是因为郁热在内部的原因，或者散布在各条经络，各自取其经而治疗。热病即与温病相同，只是发生在夏至后，脉洪数，热渴更严重罢了。虽然因为冬天受寒，伏藏在肌骨，然而人身随着天气变化，春分则寒变为温，夏至则寒变为热。所以，伤寒恶寒而不渴，温热不恶寒而渴。不恶寒则病非外来，渴则自内达表，热郁腠理，不得外泄，乃复还里，终归是里多表少。间或有恶寒的，那是冒犯了非时的暴寒，或者温暑将要发作，又受到暴寒，不是冬季证候那么严重。治法应当以治里热为主，而解肌次之，也有专治里而表自解的。误用下法还可以，误用汗法则变为呕、哕、狂、斑而死。大概温热在经而不在表，怎么可以一律使用伤寒的汗法！只有兼有暴寒的，才可以表里双解，也不敢用冬天的辛温药物。春温表证，天温暖用升麻葛根汤；天寒冷用柴胡桂枝汤。太阳合少阳，败毒散合小柴胡；太阳合阳明，败毒散合升麻葛根；阳明合少阳，升麻葛根汤合小柴胡汤。半表里用小柴胡。里证用大柴胡。重症的，一时表里俱发，用防风通圣散。表里俱热，大便自利的，用柴苓汤加山栀、木通。虚烦用竹叶石膏汤。变为杂证，全同伤寒。夏热表证，太阳经用九味羌活汤；发汗后烦渴，脉洪大，背恶寒的，用白虎加人参汤、益元散。里证用大柴胡。重症的，一时表里盛发，用双解散。热病脉细无力，足冷，已经出汗而躁动盛的，这是阴脉的极期，必死。详见温暑门。
晚发疑似秋季的病，请教高明之士；
前辈说：清明至夏至前，患太阳病的，称为晚发，比之温病稍轻。大概因为感受轻的发得早，感受重的发得迟。从立秋至霜降，有患太阳证的，也叫温病，治法同温热，只是在解肌药中加入燥剂，里证同于伤寒。既然以三月至夏至为晚发，春分前又为正伤寒，不知道春温在何月，再考证三月至夏至前，名为春温，则晚发应当属于秋季了。立秋前后发病的，因湿热而发；处暑后发病的，因燥热而发，这样四时六气，完备而不混淆，而治疗各自随其时令而已。
大概表证，用九味羌活汤、栀子升麻汤；里证，用大柴胡汤加生地，或者导滞通幽汤。变为杂证的，随宜施治。
冬温总是时行病，加上调理。
冬天有非时的温暖，名叫冬温。与春秋暴寒、暴温总称为时行气，与伤寒相似，只是脉不浮。治法大同春温。
表证，用葳蕤汤、九味羌活汤，入里加大黄，重症用双解散，轻症用加减调中汤。
静而得之为中暑，动而得之为中暍。
暑、暍都表现为自汗烦渴，脉虚，面垢昏倦。静而热伤心脾为中暑，与夏热病相似，但热病脉洪紧，中暑脉细数而沉。动而热伤太阳为中暍，脉浮似夏伤风。但汗出恶风，身热而不渴的，是伤风。汗出恶寒身热而渴的，是中暍。加之身体疼痛且沉重的，必定是夏月伤冷，或者澡浴水行皮中所致。中暍心腹疼痛，霍乱吐泻转筋，甚至发厥昏闷，用香薷散；痰逆恶心恶寒的，用橘皮竹茹汤；汗多渴而不恶寒的，用竹叶石膏汤；暑湿相搏，身痛心痛烦渴恶心尿赤的，用五苓散；湿盛胸满的，用瓜蒂散吐之；如果小便已，洒然毛耸，口开前板齿燥黑，肢厥，小劳身即热的，表里都病了，用白虎加人参汤；有湿的，用白虎加苍术汤调和。切忌汗下针灸，汗则恶寒，下则内虚变淋，灸则助火发热。
中暑发热烦躁口渴的，用小柴胡汤加香薷；泻利口渴的，用香薷散合四苓散；元气素弱，脉虚身倦的，用清暑益气汤；昏愦不苏醒的，用葱饼熨脐。
暴寒寒疫，与伏藏已变之寒，自然是情势违背；
春分至秋分，暴寒叫寒疫，不是冬月伤寒可比。三月四月，或有暴寒，阳气尚弱，被寒所折抑，病热还轻。五月六月，阳气已盛，被寒所折抑，病热则重。七月八月，阳气已衰，被寒所折抑，病热也微。感染它的，其病与温暑相似。而治疗则不同，大概温暑伏寒自内而发，寒疫自外而入，宜用调中汤为主，随时气候寒热轻重而以辛凉、辛温的药物加减。大概折，是折抑阳气，郁结而为热。感受轻而阳气不被折抑，未到发热的，应当在感冒药中寻求。
暴温温疫，与过经不除之温，都难用汗法发越。
春三四月间，暴热伤人的，也叫温病。伤寒汗下过经不解的，也叫温病。但应当随各经见证治疗，都不宜汗下。暴温，用栀子升麻汤、九味羌活汤。过经，用和解散、参胡芍药汤。
风温喘渴多睡，四肢不收若瘫痪；
太阳病，发汗则身凉。如果发汗身仍灼热的，乃是风温。当春温气大行，又感风邪所致。只有风伤卫，四肢缓纵不收像瘫痪那样；只有温伤气，气昏而鼻息不利，语言謇涩，身热自汗多眠。治疗在心火肝木二经，忌汗、下、针。误汗则身必灼热，甚至烦渴谵黄；下则遗尿；针则耳聋。只有清解肌表为佳，宜用葳蕤汤、败毒散，或小柴胡加桂枝微汗之。渴甚的，用栝蒌根汤。痰喘的，用金沸草散加杏仁、细辛、五味子。误汗，用防己黄芪汤救治。谵语独语及直视遗尿的难治。
湿温胸满妄言，两胫逆冷如雪；
夏月先伤湿，而后伤暑，名叫湿温。湿与热搏，两胫逆冷，甚至遍身也冷，胸满头痛，壮热自汗。如果再发汗，令人呕吐耳聋，身变青色，不语，名叫重暍，必死。治疗在心火脾土，用茯苓白术汤，湿胜溺涩便利的，用五苓散、除湿汤。脏滑的，用术附汤。暑胜壮热二便涩的，用香薷散、六和汤。便闭渴谵，用白虎加苍术汤。
风湿，头汗身重而大便难；
先伤湿而后伤风，风先上受，湿先下受，风湿相搏，风在外而湿在内。大汗则其气暴而内邪不能出，所以风去而湿存，湿流入里则病重。微汗则其气缓而内外之邪俱去，或者湿证去而风证未去的，不久自解。寒热身痛，用麻杏薏甘汤；体痛发热，小便不利，用麻黄汤加苍术；肩背脊腰强痛的，用羌活胜湿汤；肿痛微喘，用杏仁汤；汗多，用汉防己汤；虚的，身重难以转侧，用桂枝汤加白术；身重昏迷，自汗失音，下利不禁的，用白通汤加白术、甘草；身痛小便不利的，用甘草附子汤；身重走痛的，用小续命汤去麻黄、附子；热而重痛烦渴的，用败毒散去柴胡、人参，加栝蒌根。小便自利及下利不止的，死。
Cold damage manifests as aversion to cold, absence of sweating, and slight coldness in the hands and feet;
After Frost's Descent (Shuangjiang) and before Spring Equinox (Chunfen), individuals traveling on roads may tread on frost and ice, exposing themselves to cold pathogenic factors, thereby developing illness, termed Cold Damage (Shanghan). It invariably begins with aversion to cold, severe headache, absence of nasal discharge, a voice that is initially light and subsequently heavy, and a normal taste sensation in the mouth. Although appetite may be absent, there is no disgust for food, and the extremities are not hot. In severe cases, body pain accompanied by fever occurs. In winter, Mahuang Tang (Ephedra Decoction) is used; for mild cases, Tao's Mahuang Tang is prescribed; for deficiency patterns, Renshen Shunqi San (Ginseng Regulating Qi Powder) is employed; during the three seasons (spring, summer, autumn), Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) or Xiaochaihu Tang (Minor Bupleurum Decoction) are used; the general formula is Mahuang Xingren Yin (Ephedra and Apricot Seed Drink). This specifically differentiates anhidrosis as characteristic of Cold Damage, whereas Wind, Summerheat, and Dampness all involve sweating; only Cold causes blood to congeal and results in anhidrosis. Regarding initial manifestations, transmission changes, and miscellaneous syndromes, details follow later.
Wind injury manifests as aversion to wind, spontaneous sweating, and slight restlessness in the hands and feet.
The initial symptoms of Wind Injury—headache, normal taste, and lack of food aversion—are identical to Cold Damage. Since Cold is a Yin pathogen and Wind is a Yang pathogen, Cold Damage requires stagnation before fever develops, whereas Wind Injury induces fever immediately. In Cold Damage, extremities are slightly cold; in Wind Injury, the dorsum of the hands and feet is hot. Cold Damage presents with no nasal discharge; Wind Injury presents with nasal discharge and a muffled voice as if from a jar. Cold Damage features a pale complexion and body pain; Wind Injury features a lustrous complexion and heaviness of the body. Cold Damage involves anhidrosis and aversion to cold but not aversion to wind; Wind Injury involves sweating, aversion to wind but not aversion to cold. Severe cases present with continuous spontaneous sweating, shivering aversion to wind, and trembling aversion to cold. In winter, Guizhi Tang (Cinnamon Twig Decoction) is used; for spontaneous sweating with frequent urination, Shaoyao Gancao Tang (Peony and Licorice Decoction) is prescribed; for spontaneous sweating with free urination and curling of the feet, Guizhi Tang plus Renshen (Ginseng) and Fuzi (Aconite) is used; for mild cases, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is employed; for spontaneous sweating with thirst and difficult urination, indicating pathogen transmission inward, Wuling San (Five-Ingredient Powder with Poria) is used; for spontaneous sweating without thirst, indicating pathogen remains at the exterior, Fuling Guigan Tang (Poria, Cinnamon Twig, and Licorice Decoction) is prescribed; during the three seasons, Fangfeng Chonghe Tang (Saposhnikovia Harmonizing Decoction) or Chaihu Guizhi Tang are used, or Baidu San (Hundred-Resist Powder) minus Fuling (Poria); for nasal congestion, Tongguan San (Pass-the-Pass Powder) is applied; the general formula is Chaihu Banxia Tang (Bupleurum and Pinellia Decoction). Ancient formulas for Wind Injury across the Six Channels are found under Guizhi Tang. However, medicines for the Three Yin channels are all acrid and warm, which seems inconsistent with Zhang Zhongjing's methods. Zhang Zhongjing differentiated exogenous syndromes by presence or absence of sweating, and interior syndromes by harmonization or purgation, without further distinction. Now discussing Ba Wu (Eight Substances) including Guizhi and Fuzi: this likely applies when Wind Pathogen directly injures the Yin aspect, in persons with inherent deficiency, or after sexual activity. If used generally for exterior syndromes, it would cause much harm. Generally, for releasing the exterior in Wind Injury, acrid-warm is superior to acrid-hot, and acrid-cool is superior to acrid-warm. Some question why Zhang Zhongjing detailed Wind and Cold but neglected Summerheat, Dampness, Dryness, and Fire among the Six Excesses. This is because Summerheat and Fire share the same nature, and Dryness and Dampness share the same source. Wind and Cold transmit through the Six Channels, while Summerheat and Dampness tend to affect the Five Zang organs. Robust individuals recover as Qi circulates, while frail individuals develop disease due to pathogen attachment. "Se se" refers to insufficiency; "sa sa" refers to shivering; both describe the appearance of aversion to wind.
Treating simultaneous exterior and interior urgency, treating simultaneous interior and exterior urgency, where Yin and Yang channels are affected together is called Liang Gan (Dual Infection);
Liang Gan involves half the pathogen entering Yang channels and half entering Yin channels, affecting both Yin and Yang, thus involving all Zang and Fu organs. On the first day, Taiyang (Greater Yang) and Shaoyin (Lesser Yin) are affected simultaneously: headache indicates Taiyang pathogen excess at the exterior; dry mouth and thirst indicate Shaoyin pathogen excess at the interior. On the second day, Yangming (Yang Brightness) and Taiyin (Greater Yin) are affected: fever and delirium indicate Yangming pathogen excess at the exterior; anorexia and abdominal fullness indicate Taiyin pathogen excess at the interior. On the third day, Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) are affected: deafness indicates Shaoyang pathogen excess at the exterior; retraction of the scrotum and cold limbs indicate Jueyin pathogen excess at the interior. When all Zang and Fu organs are diseased, attempting to treat the exterior while the interior is urgent, or treating the interior while the exterior is urgent, leads to death. However, those with strong constitution and shallow pathogen invasion, or those with mixed pathogens like Feng Wen (Wind-Warmth) or Shi Wen (Damp-Warmth), may still be saved. Thus, Zhang Zhongjing established sequences of treatment, such as releasing the exterior before purging the interior. The method requires assessing the urgency and deficiency/excess of the exterior and interior. If both are urgent, Da Qianghuo Tang (Major Notopterygium Decoction) is the primary treatment. If Yang channel diseases occur first, with body pain but no diarrhea, the exterior is urgent; treat first with Gegen (Kudzu Root) and Mahuang (Ephedra) to release the exterior, then with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) to purge the interior. If Yin channel diseases occur first, with body pain and unceasing diarrhea, the interior is urgent; treat first with Sini Tang (Frigid Extremities Decoction) to rescue the interior, then with Guizhi Tang (Cinnamon Twig Decoction) to rescue the exterior. If Yin and Yang are indistinguishable, Tao's Chonghe Tang is used for exploration. Ancient methods: Day 1 Taiyang-Shaoyin dual infection, use Wuling San; add Qianghuo (Notopterygium) and Fangfeng (Saposhnikovia) for headache; add Huangbai (Phellodendron) and Zhimu (Anemarrhena) for thirst. Day 2 Yangming-Taiyin dual infection, use Dachaihu Tang (Major Bupleurum Decoction). Day 3 Shaoyang-Jueyin dual infection, critical condition, use Dachengqi Tang (Major Order the Qi Decoction) plus Chuanxiong (Ligusticum) and Chaihu (Bupleurum) to rescue. *Ren Shu* (Book of Vitality) ignores Yin-Yang differentiation, using only Sini Tang and Guizhi Tang, which predecessors considered erroneous. Generally, in Liang Gan, a pulse following Yang is treatable, while one following Yin is difficult to treat.
Wind Injury presenting with Cold Damage pulse, or Cold Damage presenting with Wind Injury pulse, where pulse and syndrome contradict each other.
If Cold Damage precedes Wind Injury, the syndrome is Cold Damage but the pulse resembles Wind Injury; if Wind Injury precedes Cold Damage, the syndrome is Wind Injury but the pulse resembles Cold Damage. This occurs when Ying (Nutrient) and Wei (Defensive) Qi are both excessive, resulting in anhidrosis and irritability, treated with Da Qinglong Tang (Major Blue-Green Dragon Decoction). Without irritability, Guima Gehan Tang (Half-Cinnamon Twig Half-Ephedra Decoction) is used. General formulas include Da Qianghuo Tang, Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) plus Renshen and Dazao (Jujube), or Shenzhu San (Divine Skill Powder) and Xiangsu San (Fragrant Perilla Powder).
Three Yang Combined Disease, spontaneous diarrhea, and post-sweat/purge assessment of meridian vs. fu organ involvement.
If one Yang channel is diseased first followed by another, or two or three Yang channels are diseased simultaneously without transmission, it is called Combined Disease. Spontaneous diarrhea refers to loose stools. Three Yang Combined Disease indicates severe Cold pathogen and disharmony of interior Qi. Downward movement of Qi causes diarrhea; upward rebellion causes vomiting. Taiyang combined with Yangming causing spontaneous diarrhea: if aversion to cold exists, use Shengma Gegen Tang (Cimicifuga and Kudzu Root Decoction); if aversion to heat exists, use Baihu Tang (White Tiger Decoction). Taiyang combined with Shaoyang causing spontaneous diarrhea: use Huangqin Tang (Scutellaria Decoction); if vomiting occurs, add Banxia (Pinellia) and Shengjiang (Fresh Ginger). Yangming combined with Shaoyang causing spontaneous diarrhea is most severe; use Xiaochaihu Tang combined with Shengma Gegen Tang. For cases requiring purgation: originally Taiyang disease, due to excessive sweating or purging leading to fluid depletion and dryness in the Stomach Fu, transforming into Yangming, termed Taiyang-Yangming, treat with Pi Yue Wan (Spleen Restriction Pill) to moisten. Originally Shaoyang disease, due to sweating causing heat to enter the Stomach Fu and dry stool, use Dachaihu Tang for mild purgation. Originally Yangming Meridian disease, with intense heat transmitting to the Stomach Fu, termed Zhengyang Yangming (True Yang Yangming), which is self-originated disease of its own meridian, treat with Tiaowei Chengqi Tang from the middle jiao. Generally, Taiyang lacks Qi, Shaoyang lacks Blood, while Yangming, situated between the two Yangs, has abundant Qi and Blood; thus, treating Yangming from the middle avoids injuring Taiyang and Shaoyang. Additionally, in Three Yang Combined Disease, with facial grease, abdominal fullness, body heaviness preventing turning, delirium, enuresis, dry mouth, numbness, and difficult defecation, use Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction); sweating and purging are contraindicated, representing another middle-jiao treatment method. For cases requiring sweating: if exterior symptoms like headache and aversion to cold persist, indicating Taiyang disease has not passed the meridian stage, sweating is particularly appropriate. For Taiyang-Yangming with wheezing and chest fullness, use Mahuang Tang. For Taiyang-Shaoyang, combine Mahuang Tang with Xiaochaihu Tang. General formula: Jiwei Qianghuo Tang plus Shigao (Gypsum), Zhimu, and Zhike (Aurantium). Generally, disease in the meridian allows sweating; passing the meridian requires purgation.
Three Yang Concurrent Disease, allowing sweating and purging, must transmit to the Stomach and root.
"Bing" implies pressing together. Initially, two Yang channels are combined; later, one becomes vigorous and the other weak, merging into one dominant channel, while initial symptoms remain unresolved. Yangming concurrent with Taiyang: Taiyang syndrome unresolved, Yangming syndrome appears; combine Mahuang Tang with Shengma Gegen Tang. If Taiyang syndrome is heavier, add Taiyang channel herbs; if Yangming is heavier, add Yangming channel herbs, following this pattern for others. Shaoyang concurrent with Taiyang: Taiyang syndrome unresolved, Shaoyang syndrome appears; combine Mahuang Tang with Xiaochaihu Tang. Also suitable for headache, neck stiffness, dizziness resembling Jie Xiong (Chest Binding). General formula: Jiwei Qianghuo Tang. Shaoyang concurrent with Yangming: Wood overacting on Earth, difficult to treat; combine Xiaochaihu Tang with Shengma Gegen Tang and Chaihu Shengma Tang. For concurrent diseases at the exterior, sweating is applicable. If Taiyang syndrome resolves and the pathogen enters the Stomach Fu, it is termed Transmission (Chuan Jing), not concurrency; treat according to constitution with purgation. Old theory states: Three Yin channels have no combined or concurrent diseases. However, Three Yin channels can merge internally, but never merge with Yang channels unless it is Liang Gan.
Only knowing that Yi Li (Epidemic Toxins) are contagious,
Yi, resembling ghostly plagues, is called Yi Li or Shi Qi (Seasonal Qi). Spring should be warm but is clear; summer should be hot but is cool; autumn should be cool but is very hot; winter should be cold but is very warm. Non-seasonal Qi occurs. Those infected immediately develop headache, body pain, chills, and fever; everyone in one area suffers similar illnesses. Treatment differs slightly from Cold Damage: Spring clears Liver, use Shengma Gegen Tang; Summer clears Heart, use Er Xiang San (Two Fragrances Powder) and Tiaozhong Tang (Regulate Middle Decoction); Autumn clears Lung, use Baihu Jia Cang Zhu Tang (White Tiger Plus Atractylodes Macrocephala Decoction) and Yinchin Wuling San (Artemisia Capillaris Five-Ingredient Powder with Poria); Winter clears Kidney, use Weirui Tang (Polygonatum Decoction) and Ganjie Tang (Licorice and Platycodon Decoction); Earth prospers in all four seasons, treat by channel selection. Treatments same as Cold Damage: Exterior syndrome, Baidu San; Half-exterior/Half-interior, Xiaochaihu Tang; Interior syndrome, Dachaihu Tang; With internal injury, tonify, disperse, or descend, e.g., Renzhonghuang Wan (Human Midden Yellow Pill). Classics state: Epidemic Qi is not confined to pulse diagnosis; seek it in Yun Qi (Luck and Qi) theory. Families with epidemics should take Sesame Oil, or dip paper twists in Sesame Oil mixed with Xionghuang (Realgar) and Zhusha (Cinnabar) powder, inserting into nose and ears to avoid foul toxins. Using Ruyi Dan (As-Desired Pellet) widely in villages is also excellent.
How could one know that Zheng Qi (Upright Qi) often fails?
Classics state: Spring Qi is mild, Summer Qi is hot, Autumn Qi is cool, Winter Qi is cold. Considering Cold Damage as toxic because it embodies the most lethal Qi. If injured by Four Qi, which channel retains it and what disease arises? Generally: Spring Wind injury leads to Summer Sundry Diarrhea (Sun Xie); Summer Summerheat injury leads to Autumn Malaria and Dysentery; Autumn Dampness injury leads to Winter Cough; Winter Cold injury leads to Spring Malaria. Dan (feverish malaria) occurs every two days; Nue (malaria) occurs daily. Autumn Dampness not immediately manifesting combines with Winter Wind-Cold to produce Phlegm-Dampness cough. Winter Cold not immediately manifesting combines with Spring Warmth to become Wen Bing (Warm Disease). Thus, Four Seasons Zheng Qi can also become disordered. Tracing back from onset to source, rather than predicting today's illness from the time of injury, some dissipate without becoming disease. How can one adhere to a single view? If feeling internal Qi excess and abdominal discomfort, use Bu Huan Zheng Qi San (Non-Replacing Upright Qi Powder) modified to regulate Stomach Qi.
Spring transforms into Warmth, Summer transforms into Heat.
Wen Bing (Warm Disease): After Spring Equinox, Taiyang disease presents with fever, cough, body pain, thirst, no aversion to cold, wiry-rapid non-tight pulse, right hand pulse stronger than left, due to internal stifling heat. Or dispersed in various channels, treat by channel. Re Bing (Heat Disease) is same as Wen Bing but occurs after Summer Solstice, with surging-rapid pulse and more severe heat/thirst. Though caused by Winter Cold lying dormant in muscles/bones, the human body transforms with Heaven's Qi: Spring Equinox turns Cold to Warmth, Summer Solstice turns Cold to Heat. Thus, Cold Damage has aversion to cold without thirst; Warmth/Heat has no aversion to cold but has thirst. No aversion to cold means pathogen is not external; thirst means heat reaches exterior from interior. Heat stagnates in cou li (pores), cannot escape, returns interior, resulting in more interior than exterior. Occasional aversion to cold is due to sudden non-seasonal cold or pre-febrile warmth struck by sudden cold, not severe Winter syndrome. Method: prioritize clearing interior heat, secondary resolving muscle layer. Some resolve exterior by treating interior alone. Mistaken purgation is tolerable; mistaken sweating leads to vomiting, hiccups, mania, macules, and death. Warmth/Heat is in the meridian, not exterior; how can Cold Damage sweating methods be applied? Only with concurrent sudden cold can exterior-interior be resolved simultaneously, avoiding Winter acrid-warm drugs. Spring Warmth exterior syndrome: warm weather, Shengma Gegen Tang; cold weather, Chaihu Guizhi Tang. Taiyang-Shaoyang, Baidu San combined with Xiaochaihu Tang; Taiyang-Yangming, Baidu San combined with Shengma Gegen Tang; Yangming-Shaoyang, Shengma Gegen Tang combined with Xiaochaihu Tang. Half-exterior/interior, Xiaochaihu Tang. Interior, Dachaihu Tang. Severe cases with simultaneous exterior-interior onset, Fangfeng Tongsheng San (Saposhnikovia Unblocking Success Powder). Exterior-interior heat with spontaneous diarrhea, Chai Ling Tang (Bupleurum and Poria Decoction) plus Zhizi (Gardenia) and Mutong (Akebia). Deficient irritability, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Miscellaneous transformations follow Cold Damage rules. Summer Heat exterior syndrome: Taiyang, Jiwei Qianghuo Tang; post-sweating irritability/thirst, surging pulse, back aversion to cold, Baihu Jia Renshen Tang and Yi Yuan San. Interior, Dachaihu Tang. Severe simultaneous onset, Shuangjie San (Double Resolution Powder). Heat disease with fine-weak pulse, cold feet, sweating with severe agitation indicates extreme Yin pulse, fatal. See Wen Shu section.
Late onset suspected as Autumn disease, consulting experts;
Predecessors say: From Clear Brightness to before Summer Solstice, Taiyang disease is called Late Onset, slightly milder than Warm Disease. Lighter infection manifests early; heavier manifests late. From Start of Autumn to Frost's Descent, Taiyang syndrome is also called Warm Disease, treated same as Warmth-Heat, adding drying agents to muscle-resolving formulas; interior syndrome same as Cold Damage. Since March to Summer Solstice is Late Onset, and before Spring Equinox is True Cold Damage, when does Spring Warmth occur? Re-examining March to Summer Solstice as Spring Warmth, Late Onset belongs to Autumn. Diseases around Start of Autumn arise from Damp-Heat; after End of Heat, from Dry-Heat. Thus Four Seasons Six Qi are complete and distinct, treated according to season.
Generally exterior: Jiwei Qianghuo Tang, Zhizi Shengma Tang; interior: Dachaihu Tang plus Shengdi (Rehmannia) or Daozhi Tongyou Tang (Guide Stasis Unblock Hidden Decoction). Miscellaneous transformations treated appropriately.
Winter Warmth is always Seasonal, requiring regulation.
Winter non-seasonal warmth is called Dong Wen (Winter Warmth). Similar to Spring/Autumn sudden cold/warmth as Seasonal Qi, resembling Cold Damage but pulse is not floating. Treatment largely same as Spring Warmth.
Exterior: Weirui Tang, Jiwei Qianghuo Tang; entering interior add Dahuang (Rhubarb); severe, Shuangjie San; mild, Ji Jian Tiaozhong Tang.
Still acquisition is Zhong Shu (Summerheat Stroke), active acquisition is Zhong Yue (Heat Stroke).
Shu and Yue both present with spontaneous sweating, irritability, thirst, deficient pulse, greasy face, drowsiness. Still heat injuring Heart/Spleen is Zhong Shu, similar to Summer Heat disease, but pulse is surging-tight for Heat, fine-rapid-deep for Shu. Active heat injuring Taiyang is Zhong Yue, floating pulse resembling Summer Wind Injury. Sweating with aversion to wind, body heat without thirst is Wind Injury. Sweating with aversion to cold, body heat with thirst is Zhong Yue. Plus body pain/heaviness indicates Summer Cold injury or water entering skin during bathing. Zhong Yue causes abdominal pain, Huoluan (Colic-Rotation) vomiting/diarrhea with cramps, even fainting; use Xiangru San (Elsholtzia Powder). Phlegm-rebellion, nausea, aversion to cold: Chupi Zhuru Tang (Tangerine Peel and Bamboo Sheath Decoction). Sweating, thirst, no aversion to cold: Zhuye Shigao Tang. Summerheat-Dampness binding, body/heart pain, irritability, thirst, nausea, red urine: Wuling San. Dampness excess with chest fullness: Gouti San (Melon Sepal Powder) for emesis. After urination, shivering hair erection, open mouth, dry/black front teeth, cold limbs, heat upon slight exertion indicates both exterior and interior disease: Baihu Jia Renshen Tang. With dampness: Baihu Jia Cang Zhu Tang. Strictly avoid sweating, purging, acupuncture. Sweating causes aversion to cold; purging causes interior deficiency and strangury; moxibustion aids fire and fever.
Zhong Shu with fever, irritability, thirst: Xiaochaihu Tang plus Xiangru; diarrhea with thirst: Xiangru San combined with Siling San. Inherent weak Yuan Qi, deficient pulse, fatigue: Qingshu Yiqi Tang (Clear Summerheat Benefit Qi Decoction). Coma/unconsciousness: Scallion cake moxa on umbilicus.
Sudden Cold Cold Epidemic, and latent transformed Cold, naturally contrary in nature;
From Spring Equinox to Autumn Equinox, sudden Cold is Han Yi (Cold Epidemic), not comparable to Winter Cold Damage. March-April, sudden Cold with weak Yang, suppressed by Cold, heat illness is mild. May-June, strong Yang suppressed by Cold, heat illness is severe. July-August, declining Yang suppressed by Cold, heat illness is slight. Infection resembles Warmth/Summerheat but treatment differs: Warmth/Summerheat Cold lies within and emerges internally; Cold Epidemic enters externally. Primary treatment: Tiaozhong Tang, modified with acrid-cool or acrid-warm based on climate severity. "Zhe" means suppressing Yang Qi, stagnating into Heat. Light infection not suppressing Yang, no fever yet: seek in Cold Remedy formulas.
Sudden Warmth Warm Epidemic, and Warmth not resolving after passing meridian, both difficult to sweat out.
March-April, sudden Heat injury is also called Wen Bing. Cold Damage sweating/purgation failing to resolve after passing meridian is also called Wen Bing. Treat according to channel symptoms; sweating and purging are unsuitable. Sudden Warmth: Zhizi Shengma Tang, Jiwei Qianghuo Tang. Passed meridian: Hejie San (Harmonize Resolve Powder), Canhu Shaoyao Tang (Ginseng-Bupleurum Peony Decoction).
Wind-Warmth wheezing/thirst/sleepiness, limbs flaccid like paralysis;
Taiyang disease, sweating cools body. If body remains burning after sweating, it is Wind-Warmth. Caused by prevalent Spring Warmth Qi combined with Wind Pathogen. Wind injures Wei (Defensive) Qi, causing limbs flaccid and unrestrained like paralysis; Warmth injures Qi, causing mental confusion, difficult breathing, slurred speech, fever, spontaneous sweating, and sleepiness. Treat Heart Fire and Liver Wood channels. Avoid sweating, purging, needling. Mistaken sweating causes burning heat, irritability, thirst, delirium, yellow complexion; purging causes enuresis; needling causes deafness. Best is clearing/resolving muscle layer: Weirui Tang, Baidu San, or Xiaochaihu Tang plus Guizhi for mild sweating. Severe thirst: Gualou Gen Tang (Trichosanthes Root Decoction). Phlegm-wheezing: Jinfei Cao San (Boiling Grass Powder) plus Xingren (Apricot Seed), Xixin (Asarum), Wuweizi (Schisandra). Mistaken sweating: Fangji Huangqi Tang (Stephania and Astragalus Decoction) to rescue. Delirium, muttering, fixed gaze, enuresis: difficult to treat.
Damp-Warmth chest fullness/hallucinations, lower legs cold as snow;
Summer: Dampness injury first, then Summerheat, called Shi Wen (Damp-Warmth). Damp-Heat binding causes cold lower legs, even whole body cold, chest fullness, headache, high fever, spontaneous sweating. Further sweating causes vomiting, deafness, blue complexion, muteness, termed Heavy Yue, fatal. Treat Heart Fire and Spleen Earth: Fuling Baizhu Tang. Dampness excess with difficult urination/free stool: Wuling San, Chushi Tang (Remove Dampness Decoction). Visceral slipperiness: Shu Fu Tang (Atractylodes and Aconite Decoction). Summerheat excess with high fever and difficult urination/defecation: Xiangru San, Liuhe Tang (Six-Harmony Decoction). Constipation, thirst, delirium: Baihu Jia Cang Zhu Tang.
Wind-Dampness head sweating/body heaviness/difficult defecation;
Dampness injury first, then Wind. Wind enters upper, Dampness enters lower. Wind-Damp binding: Wind outside, Dampness inside. Heavy sweating makes Qi violent, internal pathogen cannot exit; Wind leaves, Dampness remains, entering interior worsens disease. Mild sweating makes Qi gentle, both exterior/interior pathogens leave. If Dampness resolves but Wind remains, resolves soon. Chills-body pain: Maxing Yigan Tang (Ephedra, Apricot Seed, Coix, Licorice Decoction). Body pain-fever-difficult urination: Mahuang Tang plus Cangzhu (Atractylodes Lancea). Shoulder-back-spine-lumbosacral stiffness: Qianghuo Shengshi Tang (Notopterygium Resisting Dampness Decoction). Swelling-pain-mild wheezing: Xingren Tang. Heavy sweating: Han Fangji Tang (Stephania Decoction). Deficiency, body heaviness hard to turn: Guizhi Tang plus Baizhu (Atractylodes Macrocephala). Body heaviness-coma-spontaneous sweating-loss of voice-uncontrollable diarrhea: Baitong Tang plus Baizhu, Gancao. Body pain-difficult urination: Gancao Fuzi Tang (Licorice and Aconite Decoction). Body heaviness-wandering pain: Xiao Xuming Tang (Minor Continuation Life Decoction) minus Mahuang, Fuzi. Heat-heavy pain-irritability-thirst: Baidu San minus Chaihu, Renshen, plus Gualou Gen. Spontaneous urination and unceasing diarrhea: fatal.
Cold-Dampness head sweating-body pain-loose stools.
Cold Damage has no sweat; Cold-Damp binding has sweat, but only on head, not whole body. Back stiffness indicates exterior obstruction, similar to Wind-Dampness, treated with Shen Shi Tang (Permeate Dampness Decoction);