丹溪治一壮年。恶寒。多服附子。病甚。脉弦而似缓。以江茶入姜汁、香油些少。吐痰
一升。减绵衣大半。又与防风通圣散。去麻黄、硝、黄。加地黄。百帖而安。知其燥热已多
血伤亦深。须淡食以养胃。内观以养神。则水可升。火可降。必多服补血凉血药乃可。否
则内外不静。肾水不生。附毒必发。彼以为迂。果疽发背死。
〔附〕一女子恶寒。丹溪用苦参、赤小豆各一钱。齑水探吐。后用川芎、苍术、南星、
黄芩。酒糊丸服。
又治一妇人。年五十余。形瘦面黑。喜热恶寒。六月。两手脉沉而涩。重取似数。三黄
丸下以姜汤。每三十粒。服三十次。微汗而安。
一老妇形肥肌浓。夏恶寒战栗。喜啖热。御绵。多汗。已服附子三十余。浑身痒甚。脉
沉涩。重取稍大。知其热甚而血虚也。以四物汤去芎。倍地黄。加白术、黄 、炒黄柏、生
甘草、人参。每帖二两重。方与一帖。腹大泄。目无视。口无言。知其病热深而药无反佐之
过也。以前药炒热即煎。盖借火力为向导。与一帖。利止。四帖精神回。十帖全愈。
一人形瘦色黑。素多酒不困。年半百。有别馆。一日大恶寒。发战。自言渴。却不饮。脉
大而弱。右关稍实。略数。重取则涩。此酒热内郁。不得外泄。由表热而下虚也。黄 二两
干葛一两。煎饮之。大汗而愈。
滑伯仁治一人。七月。病发热。或令服小柴胡汤。升发太过。多汗亡阳。恶寒甚。筋惕
肉。视其脉。微欲绝。以真武汤。七八服稍愈。服附子八枚。而痊。
戴原礼治朱仲文。长夏畏寒。身挟重纩。食饮必热如火。方下咽。微温即呕。他医授以
胡椒制硫。日令啖鸡三。病愈亟。原礼曰。脉数而大。且不弱。刘守真云。火极似水。此之
谓矣。椒发阴经之火。鸡能助痰。只以益其病耳。以大承气汤下之。昼夜行二十余。顿减纩
之半。复以黄连导痰汤加竹沥。饮之竟瘳。
震按古云。伤寒则恶寒。又云。恶寒多属阳虚卫弱。故参、附、 、术是正药。诸案或
清或下。或治痰。又古语所谓恶寒非寒也。要知丹溪原礼之防风通圣、四物、黄柏、大承气
黄连导痰等方。皆因其人多服热药而病益甚。且脉不微弱也。此与东垣治目赤。烦渴引饮
脉七八至。按之则散。为无根之火。用姜、附、人参而愈者。假寒假热。正可互参。至
如南
史载直阁将军房伯玉。服五石散十许剂。更患冷疾。夏月常复衣。徐嗣伯诊之曰。卿伏热。
应须以水发之。非冬月不可。至十一月。寒甚。令二人挟捉伯玉。解衣坐石上。取冷水从头
浇之。彭彭有气。伯玉曰。热不可忍。乞冷冻饮料。嗣伯以水与之。一饮一斗。遂瘥。此与华元
化治一妇人长病经年。于十一月令坐石槽中。平且汲冷水灌之。云当满百。至七八灌。战欲
死。灌者惧。欲止。华不可。至八十灌。热气乃蒸出。百灌全。方令温床浓覆。汗浃出。敷
以粉。而愈。二人治法相同。而华案不载恶寒。但云世谓寒热注病。想如今之痨瘵。日发寒
热。所谓尸疰虫疰鬼疰等类耳。今人百治不效。若无华公法。安能起白骨而肉之耶。
李时珍曰。二人所病。皆伏火之证。素问所谓诸禁鼓栗。皆属于火也。治法。火郁则发
之。而二公乃于冬月平旦。浇以冷水者。冬至后阳气在内也。平且亦阳气方盛时也。折之以
寒使热。气郁遏至极。激发而汗解。乃物不极不反。是亦发之之意。素问所谓正者正治。反
者反治。逆而从之。从而逆之。疏通道路。令气调和者也。春月则阳气已泄。夏秋则阴气在
内。故必于十一月至后。乃可行之。二公之医。可谓神矣。
震按医理变化。真无把鼻处。诸先哲每云闭藏之月不可发汗。而此则必于至后行之。何
相反若是。要之善医者。二说各有一定之理。不善医者。二说均无恰合之病。此神与庸之不
同也。
朱丹溪治疗一位壮年男子，出现恶寒症状。该患者大量服用附子，导致病情加重，脉象弦而略显缓弱。朱丹溪用江茶加入少许姜汁和香油，使其吐出痰液一升，患者的畏寒症状减轻了一半以上（减少穿厚棉衣的需求）。随后给予防风通圣散，去掉麻黄、芒硝、大黄，加入地黄，服用一百帖后痊愈。朱丹溪判断其体内燥热已多，阴血损伤也深，必须清淡饮食以养胃气，内省静修以养心神，这样肾水才能上升，心火才能下降，必须多服用补血凉血的药物才行，否则内外不安宁，肾水无法滋生，附子的毒性必然发作。患者认为这是迂腐之见，最终果然因发背疽而死。
〔附〕有一位女子恶寒，朱丹溪用苦参、赤小豆各一钱，用醋水探吐。后来用川芎、苍术、南星、黄芩，用酒糊制成丸药服用。
又治疗一位五十多岁的妇人，形体消瘦面色黑，喜热恶寒。六月时，两手脉象沉而涩，重按似数。用三黄丸泻下，以姜汤送服，每次三十粒，服用三十次，微汗出而病愈。
一位老年妇人形体肥胖肌肉厚实，夏季恶寒战栗，喜欢进食热物，穿着棉衣，多汗。已经服用附子三十余枚，浑身瘙痒严重，脉象沉涩，重按稍大。朱丹溪判断其热邪甚盛而血虚。用四物汤去掉川芎，加倍地黄，加入白术、黄芪、炒黄柏、生甘草、人参。每帖药重二两。只给了一帖，患者腹中剧烈腹泻，眼睛不能视物，口不能言。朱丹溪判断是病热深重且用药没有反佐导致的过失。于是将之前的药炒热后立即煎煮，借火力作为向导，再给一帖，腹泻停止，四帖后精神恢复，十帖后完全痊愈。
一位男子形体消瘦肤色黑，平时喝酒很多却不醉。年近半百，有一处别馆。一天突然极度恶寒，身体发抖，自述口渴，却不喝水。脉象大而弱，右关脉稍实略数，重按则涩。这是酒热内郁，不得外泄，由表热而下焦虚损所致。用黄芪二两、干葛一两，煎汤饮用，大汗出而痊愈。
滑伯仁治疗一人。七月时，患病发热。有人让他服用小柴胡汤，升发太过，导致多汗亡阳，恶寒非常严重，筋惕肉瞤（肌肉跳动）。诊视其脉象，微细欲绝。用真武汤，服用七八帖后稍有好转，共服用附子八枚，病愈。
戴原礼治疗朱仲文。长夏时节畏寒，身上裹着厚厚的棉絮，饮食必须像火一样热，方剂刚下咽，稍微变温就会呕吐。其他医生给他胡椒制的硫磺，每天让他吃三只鸡，病情更加危急。戴原礼说：脉象数而大，且不弱。刘守真说：火极似水，说的就是这种情况。花椒会引发阴经之火，鸡肉能助长痰湿，只会增加病情罢了。用大承气汤泻下他，昼夜排便二十多次，棉絮减半，再用黄连导痰汤加竹沥饮用，最终痊愈。
俞震按语：古语说，伤寒则恶寒，又说恶寒多属阳虚卫弱，所以人参、附子、干姜、白术是正药。上述医案中有的用清法，有的用下法，有的治痰，这正是古语所说的“恶寒非寒也”。要知道朱丹溪、戴原礼所用的防风通圣散、四物汤、黄柏、大承气汤、黄连导痰汤等方剂，都是因为患者多服热药导致病情加重，且脉象不微弱。这与李东垣治疗目赤、烦渴引饮、脉七八至、按之则散，认为是无根之火，用人参、干姜、附子而痊愈的情况类似，都是假寒假热，可以互相参照。至于《南史》记载直阁将军房伯玉，服用五石散十余剂后，更患冷疾，夏天常穿多层衣服。徐嗣伯诊断说：你是伏热，应当用水来发散它，非冬天不可。到了十一月，寒气很重，让人架住房伯玉，脱衣坐在石头上，取冷水从头浇下。房伯玉感到热气蒸腾，说：“热得受不了，乞求冷冻饮料。”徐嗣伯给水他喝，一饮就是一斗，于是病愈。这与华佗治疗一位长期患病多年的妇人，在十一月让她坐在石槽中，清晨汲冷水灌洗，说应当满一百次。到灌了七八次时，病人战栗快要死了，灌洗的人害怕想停止，华佗不同意。直到灌了八十次，热气才蒸腾出来，灌满一百次全好，然后让睡在温暖的床上严密覆盖，汗出透，敷上粉，于是痊愈。两人的治疗方法相同，但华佗的医案未记载恶寒，只说是世间的寒热注病，想必是如今的痨瘵，每日发寒热，所谓尸疰、虫疰、鬼疰之类。如今人百治不效，如果没有华佗的方法，怎么能起死回生呢？
李时珍说：两人所患的都是伏火之证，《素问》所谓诸禁鼓栗，皆属于火。治疗方法，火郁则发之。而这两位医生却在冬月清晨，用冷水浇淋，是因为冬至后阳气在内，清晨也是阳气方盛的时候。用寒冷折抑火热，使热气郁遏至极，激发而出汗而解，这是物极必反的道理，也是“发之”的意思。《素问》所谓正者正治，反者反治，逆而从之，从而逆之，疏通道路，令气调和。春月阳气已泄，夏秋阴气在内，所以必须在十一月之后才能施行。两位医生的医术，可谓神妙。
俞震按语：医理变化，真是没有固定的把握之处。各位先哲常说闭藏之月不可发汗，而这里却必须在冬至后施行。为何如此相反？总之，善于医者，两种说法各有其一定之理；不善于医者，两种说法都不切合病情。这就是神医与庸医的不同之处。
Zhu Danxi treated a young man who presented with aversion to cold. The patient had taken large doses of Fuzi (Aconite Lateralis Radix Praeparata), causing the condition to worsen; his pulse was wiry and appeared slightly slow. Zhu Danxi used Jiang tea mixed with a small amount of ginger juice and sesame oil to induce vomiting, expelling one sheng (approx. 1000ml) of phlegm. The patient's need for heavy cotton clothing was reduced by more than half. Subsequently, Fangfeng Tongsheng San (Saposhnikovia Decoction for Unblocking the Heroic Pathway) was administered, with Mahuang (Ephedrae Herba), Mangxiao (Natrii Sulfas), and Dahuang (Rhei Radix et Rhizoma) removed, and Dihuang (Rehmanniae Radix) added. After taking 100 doses, he recovered. Zhu Danxi determined that there was excessive dryness-heat and deep damage to the blood. It was necessary to eat bland food to nourish the Stomach Qi, practice introspection to nourish the Shen (Spirit), so that Kidney Water could ascend and Heart Fire could descend. He must take many doses of blood-nourishing and blood-cooling herbs. Otherwise, the interior and exterior would not be tranquil, Kidney Water would not generate, and the toxicity of Aconite would inevitably manifest. The patient considered this advice pedantic and eventually died from a carbuncle on the back.
[Appendix] A woman suffered from aversion to cold. Zhu Danxi used Kushen (Sophorae Flavescentis Radix) and Chixiaodou (Vigna Semen Rubrum), each 1 qian (approx. 3g), and induced vomiting using vinegar water. Later, he prescribed Chuanxiong (Ligustici Chuanxiong Rhizoma), Cangzhu (Atractylodis Rhizoma), Nanxing (Arisomatis Tuber), and Huangqin (Scutellariae Radix), made into pills with wine paste.
He also treated a woman over fifty years old, who was thin with a dark complexion, preferred heat, and feared cold. In June, her pulses in both hands were deep and choppy, and felt rapid when pressed heavily. She was purged with Sanhuang Wan (Three Yellows Pill), taken with ginger soup, 30 pills per dose, for 30 times. She recovered after sweating slightly.
An elderly woman was fat with thick muscles, suffered from aversion to cold and shivering in summer, liked eating hot food, wore cotton clothes, and sweated profusely. She had already taken more than 30 pieces of Fuzi (Aconite Lateralis Radix Praeparata). Her whole body itched severely, and her pulse was deep and choppy, becoming slightly larger when pressed heavily. Zhu Danxi judged that the heat was severe and blood was deficient. He used Siwu Tang (Four Substance Decoction) without Chuanxiong (Ligustici Chuanxiong Rhizoma), doubled the amount of Dihuang (Rehmanniae Radix), and added Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), fried Huangbai (Phellodendri Cortex), raw Gancao (Glycyrrhizae Radix et Rhizoma), and Renshen (Ginseng Radix et Rhizoma). Each dose weighed two liang (approx. 60g). He gave only one dose. The patient suffered severe diarrhea, could not see, and could not speak. Zhu Danxi judged that the disease heat was deep and the error lay in the lack of counter-agent in the prescription. Therefore, he fried the previous herbs until hot and decocted them immediately, borrowing the fire power as a guide. He gave another dose, the diarrhea stopped, spirit returned after four doses, and full recovery occurred after ten doses.
A man was thin with black skin, drank alcohol frequently without getting drunk, and was nearly fifty years old. He had a separate residence. One day, he suddenly experienced severe aversion to cold and trembling. He claimed thirst but did not drink. His pulse was large and weak, the right Guan position was slightly full and rapid, and choppy when pressed heavily. This was due to internal stagnation of alcohol-heat, unable to vent outward, caused by exterior heat and lower jiao deficiency. He was given Huangqi (Astragali Radix) two liang and Gange (Puerariae Lobatae Radix) one liang, decocted and drunk. He recovered after profuse sweating.
Hua Boling (Slip Bo Ren) treated a man. In July, he suffered from fever. Someone advised him to take Xiaochaihu Tang (Minor Bupleurum Decoction). The ascending and dispersing action was too strong, leading to excessive sweating and loss of Yang Qi. He suffered severe aversion to cold and muscle twitching (Jinti Routun). His pulse was faint and almost imperceptible. He was treated with Zhenwu Tang (True Warrior Decoction). After seven or eight doses, he improved slightly. He took a total of eight pieces of Fuzi (Aconite Lateralis Radix Praeparata) and recovered.
Dai Yuanli treated Zhu Zhongwen. During the late summer, he feared cold, wrapped himself in thick cotton wadding, and required food and drinks to be as hot as fire. If they cooled even slightly after swallowing, he vomited. Other doctors gave him pepper-processed sulfur and instructed him to eat three chickens daily, which exacerbated the illness. Dai Yuanli said: The pulse is rapid and large, and not weak. Liu Shouzhen said: Extreme fire resembles water; this is what is meant. Pepper ignites fire in the Yin meridians, and chicken promotes phlegm; these only aggravate the disease. He purged him with Dachengqi Tang (Major Order the Yellow Decoction). He defecated more than twenty times during the day and night, and the need for cotton wadding was halved. Then, he drank Huanglian Daotan Tang (Coptis Phlegm-Expelling Decoction) with bamboo sap, and he finally recovered.
Yu Zhen’s commentary: Ancient texts state that Taiyang syndrome involves aversion to cold, and that aversion to cold often belongs to Yang deficiency and Wei Qi weakness. Therefore, Renshen (Ginseng Radix et Rhizoma), Fuzi (Aconite Lateralis Radix Praeparata), Ganjiang (Zingiberis Rhizoma), and Baizhu (Atractylodis Macrocephalae Rhizoma) are correct medicines. However, the cases above use clearing methods, purging methods, or phlegm-resolving methods. This aligns with the ancient saying that "aversion to cold is not necessarily cold." One must understand that Fangfeng Tongsheng San (Saposhnikovia Decoction for Unblocking the Heroic Pathway), Siwu Tang (Four Substance Decoction), Huangbai (Phellodendri Cortex), Dachengqi Tang (Major Order the Yellow Decoction), and Huanglian Daotan Tang (Coptis Phlegm-Expelling Decoction) used by Zhu Danxi and Dai Yuanli were all because the patients had taken many hot drugs, worsening the disease, and their pulses were not weak. This is similar to Li Dongyuan treating red eyes, irritability, thirst with drinking, pulse rate of 7-8 beats per breath, empty upon pressure, diagnosing it as rootless fire, and curing it with Jiang (Ginger), Fuzi (Aconite), and Renshen (Ginseng). Both are false cold and false heat, and can be referenced mutually. As recorded in the *History of the Southern Dynasties*, General Fang Boyu took five-stone powder (Wushi San) for about ten doses and subsequently suffered from a cold disease, wearing multiple layers of clothing in summer. Xu Sibai diagnosed him: "You have latent heat, which must be released with water, not in winter." In November, when the cold was severe, two people held Fang Boyu, stripped him, sat him on a stone, and poured cold water over his head. Gas bubbled up. Fang Boyu said: "The heat is unbearable, I beg for frozen drink." Xu Sibai gave him water. He drank one dou (approx. 2 liters) at a time, and then recovered. This is similar to Hua Tuo treating a woman who had been ill for years. In November, he had her sit in a stone trough and pour cold water on her in the early morning, saying it should reach one hundred times. By the seventh or eighth pouring, she trembled as if dying. The person pouring the water was afraid and wanted to stop, but Hua Tuo refused. At the eightieth pouring, heat vaporized out. After one hundred pours, she was fully cured. Then she was placed on a warm bed, covered thickly, sweat poured out, powder was applied, and she recovered. The two treatments were identical, but Hua Tuo’s case did not record aversion to cold, only mentioning the worldly "cold-hot injection disease," likely resembling modern tuberculosis (Lao Zhai), characterized by daily chills and fever, such as corpse-infection, insect-infection, ghost-infection, etc. Today, if hundreds of treatments fail, without Master Hua’s method, how could one raise the dead?
Li Shizhen said: The diseases suffered by both men were latent fire syndromes. As stated in the *Su Wen*: "All cases of closure, drumming, and shivering belong to fire." The treatment principle is: When fire is stagnant, disperse it. These two doctors poured cold water in winter at dawn because after the Winter Solstice, Yang Qi is inside. Dawn is also when Yang Qi begins to flourish. Using cold to suppress heat causes the Qi to become extremely stagnant, stimulating it to release through sweating. This follows the principle that things do not reverse unless they reach an extreme, which is also the meaning of "dispersing." The *Su Wen* states: Correct treatment addresses correct patterns; contrary treatment addresses contrary patterns. Reverse to follow, follow to reverse, unblock the pathways, and harmonize the Qi. In spring, Yang Qi has leaked; in summer and autumn, Yin Qi is inside. Therefore, it can only be performed after November. The medical skills of these two gentlemen can be called divine.
Yu Zhen’s commentary: Medical principles change, truly having no fixed grip. The sages often say that in months of closure and storage, sweating should not be induced. Yet here, it must be done after the Winter Solstice. Why is it so contradictory? Essentially, skilled physicians find that both statements have their own validity; unskilled physicians find that neither statement fits the disease accurately. This is the difference between a divine physician and a mediocre one.