辨张仲景《伤寒论》曰∶伤寒者,乃冬时感寒即病之名。桂枝麻黄二汤,为当时之伤寒设,与过时之温暑者,有何
预焉?夫受病之原则同,亦可均谓之伤寒,所发之时既异,治之则不可混也。请略陈之。夫春温夏热,秋凉冬
寒者,四时之正气也,以成生长收藏之用,风亦因四时之气而成温凉寒热也。若气候严寒,风亦凛冽,天道和煦,风亦
温暖,冬时坎水用事,天令闭藏,水冰地冻,风于寒相因,而成杀厉之气,人触冒之,腠理郁塞,乃有恶风恶寒之证,
其余时月,则无此证也。仲景固知伤寒乃冬时杀厉之气所成,非比他病可缓,故其为言,特详于此书,而略于杂病,倘
能因名以求其实,则思过半矣。不幸此书传世久远,遗帙颇多。晋太医令王叔和,得散亡之余,诠次流传,其功博矣。惜
乎以己论混经,未免穿凿附会。陈无已氏因之顺文注释,并无缺疑正误之言,以致将冬时伤寒之方,通解温暑,遗祸至
今而未已也。温暑必别有方,今皆失而无征也。我朝宋景濂学士,尝叹《伤寒论》非全书,得其旨哉,盖伤寒之国中人,
必先入表,表者何?即足太阳寒水之经,此经行身之后,自头贯脊,乃有头疼脊强,恶寒之证,在他经则无
此证矣。况此经乃一身之纲维,为诸阳之主气,犹四通八达之衢,治之一差,其变有不可胜言者矣,故宜此二汤发
散表中寒邪。经曰∶辛甘发散为阳者是也。若以此汤通治春温夏热之病,则误之甚矣。
按∶麻黄桂枝汤,原为冬月伤寒正药,温暑二病,不可混施。节庵力破从来之迷,至于辩仲景书中多遗帙缺误,
归罪于王叔和之诠次,陈无已之注释,可谓发前人所未发,但仲景医书,专明伤寒,故详于寒病,略于温暑,原
不为温暑设也。
辨张仲景《伤寒论》说:所谓“伤寒”,是指在冬季感受寒邪随即发病的病名。桂枝汤和麻黄汤这两首方剂,是为当时的“伤寒”所设立的,与过时的“温病”、“暑病”有什么关系呢?虽然致病的原则相同,都可以统称为“伤寒”,但由于发病的时间不同,治疗方法就不能混淆。请让我简要陈述其中的道理。
春天温热、夏天炎热、秋天凉爽、冬天寒冷,这是四季的正常气候(正气),用来完成生长收藏的功能。风也是随着四季的气候而呈现出温、凉、寒、热的变化。如果气候极其严寒,风也凛冽刺骨;如果天道温和煦暖,风也温暖宜人。在冬季,坎水(肾/北方水气)当令,天令处于闭藏状态,水结冰地冻结,风与寒相互结合,形成杀厉(致人死伤)的邪气。人如果触犯冒犯这种邪气,腠理(皮肤毛孔及肌肉间隙)郁结闭塞,就会出现恶风、恶寒的症状,而在其他月份则没有这种症状。
张仲景本来就知道伤寒是由冬季杀厉之气形成的,不同于其他疾病可以拖延,所以他在这本书中对此论述特别详细,而对杂病则论述简略。如果能通过名称来探求其实质,那么对医理的领悟就超过一半了。不幸的是,这本书流传久远,散佚缺失很多。晋代太医令王叔和,收集了散失亡佚的残余部分,加以整理编排并流传后世,他的功劳确实博大。可惜他用个人的见解混杂了经典原文,未免有穿凿附会之嫌。陈无已(陈言)因此顺着文意进行注释,并没有提出缺疑或纠正错误的言论,导致将冬季治疗伤寒的方剂,普遍解释为适用于温病和暑病,遗留的祸患至今仍未停止。温病和暑病必定另有专门的方剂,如今都已经失传且无法考证。
我朝(明代)学士宋濂,曾经感叹《伤寒论》并非全书,他真是抓住了要领啊。大概是因为患有伤寒的人,邪气必然先侵入体表。什么是表?就是足太阳膀胱经(寒水之经)。这条经脉行于身体背部,从头贯穿脊柱,所以会出现头痛、项背强直、恶寒的症状,在其他经络则没有这些症状。况且这条经络是全身的纲维,是诸阳经的主气,就像四通八达的交通枢纽一样,治疗上只要有一点差错,其产生的变证就有说不完的严重性。所以适宜用桂枝汤和麻黄汤这两首方剂来发散体表的寒邪。经文说:“辛甘发散为阳”,就是这个意思。如果用这两首方剂通治春季温病、夏季热病,那就错误得很严重了。
按语:麻黄汤和桂枝汤,原本是冬季伤寒的正治药物,温病和暑病不可混淆施用。陶节庵极力破除历来人们的迷误,至于辨析张仲景书中多有散佚缺失错误,并将责任归咎于王叔和的整理编排和陈无已的注释,可以说是提出了前人未曾发现的问题。但是张仲景的医书专门阐明伤寒,所以详于寒病,略于温暑,原本就不是为温暑病设立的。
Translation of Zhang Zhongjing's "Treatise on Cold Damage" states: "Shanghan" (Cold Damage) refers to the disease name for illness occurring immediately after contracting cold pathogens during winter. The Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) were established for the Shanghan of that time; what relevance do they have with the Wenshu (Warmth and Summerheat diseases) of later times? Although the principle of contracting disease is the same, and all can be collectively termed Shanghan, since the time of onset differs, the treatment methods cannot be confused. Let me briefly elaborate.
Spring warmth, summer heat, autumn coolness, and winter cold are the correct Qi (vital energy) of the four seasons, serving the functions of growth, flourishing, harvesting, and storage. Wind also manifests as warm, cool, cold, or hot according to the seasonal Qi. If the climate is extremely severe and cold, the wind is biting; if the heavenly order is mild and warm, the wind is gentle. In winter, Kan Water (associated with the Kidney/Northern Water element) governs; the heavenly mandate is in a state of closure and storage, water freezes, and the ground hardens. Wind combines with cold to form a lethal pathogenic Qi. When humans encounter this, the Couli (pores and interstices) become obstructed and stagnant, resulting in aversion to wind and aversion to cold symptoms, which are absent in other months.
Zhang Zhongjing inherently understood that Shanghan was caused by the lethal Qi of winter, distinct from other ailments that could be delayed. Therefore, his discourse in this book is particularly detailed regarding this condition, while being concise about miscellaneous diseases. If one can seek the reality through the name, more than half of the understanding will be achieved. Unfortunately, due to the long transmission of this book, many scrolls have been lost. Wang Shuhe, Imperial Physician of the Jin Dynasty, collected the remaining scattered texts, edited them, and circulated them, achieving great merit. However, he unfortunately mixed his own theories with the classics, leading to forced interpretations. Chen Wuji (Chen Yan) subsequently annotated the text following the original wording without pointing out omissions or correcting errors. This led to the widespread misinterpretation that formulas for winter Shanghan were applicable to Wenshu, causing harm that persists to this day. Formulas specifically for Wenshu must exist but are now lost and unverified.
My dynasty's scholar Song Lian once lamented that the "Treatise on Cold Damage" is not a complete work; he truly grasped the essence. Generally, patients suffering from Shanghan first contract the pathogen at the Exterior (Biao). What is the Exterior? It refers to the Foot-Taiyang Bladder Channel (Cold Water Channel). This channel runs along the back of the body, from the head through the spine, manifesting as headache, stiffness of the neck and back, and aversion to cold—symptoms not found in other channels. Moreover, this channel serves as the framework of the entire body and the master of Yang Qi, akin to a major intersection. A slight error in treatment can lead to countless complications. Therefore, it is appropriate to use these two decoctions to disperse cold pathogens from the exterior. The Classic states: "Pungent and sweet substances disperse and belong to Yang." Using these decoctions to treat spring warmth or summer heat would be a grave error.
Commentary: Mahuang Tang and Guizhi Tang were originally the primary remedies for winter Shanghan; they should not be confusedly applied to Wenshu. Jie'an vigorously refuted longstanding misconceptions. By analyzing the missing chapters and errors in Zhang Zhongjing's book and attributing them to Wang Shuhe's editing and Chen Wuji's annotations, he revealed insights previously unexplored. However, Zhang Zhongjing's medical writings specifically elucidate Shanghan; thus, they detail cold diseases and briefly mention warmth and summerheat, as they were not originally intended for Wenshu.